Provider Demographics
NPI:1164995189
Name:ALZATE COBO, LUISA FERNANDA
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:FERNANDA
Last Name:ALZATE COBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 SW 136TH ST APT 2111
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5279
Mailing Address - Country:US
Mailing Address - Phone:201-918-7078
Mailing Address - Fax:
Practice Address - Street 1:12715 SW 136TH ST APT 2111
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5279
Practice Address - Country:US
Practice Address - Phone:201-918-7078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18775224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant