Provider Demographics
NPI:1164518916
Name:COSSIO, ALDO MARCELLINO (MS)
Entity Type:Individual
Prefix:MR
First Name:ALDO
Middle Name:MARCELLINO
Last Name:COSSIO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17615 SW 97 AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5636
Mailing Address - Country:US
Mailing Address - Phone:786-268-2630
Mailing Address - Fax:305-252-2778
Practice Address - Street 1:17615 SW 97 AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-5636
Practice Address - Country:US
Practice Address - Phone:786-268-2630
Practice Address - Fax:305-252-2778
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7656335 00Medicaid
FL811602400Medicaid