Provider Demographics
NPI:1427218049
Name:COYA MEDICAL CENTER, PA
Entity Type:Organization
Organization Name:COYA MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVONNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:TORRE-COYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-551-2455
Mailing Address - Street 1:2580 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2400
Mailing Address - Country:US
Mailing Address - Phone:305-551-2455
Mailing Address - Fax:305-551-9061
Practice Address - Street 1:2580 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2400
Practice Address - Country:US
Practice Address - Phone:305-551-2455
Practice Address - Fax:305-551-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42817207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E19731Medicare UPIN
FL96312Medicare PIN