Provider Demographics
NPI:1548776354
Name:COTES, MIGUEL (MA)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:COTES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 TAYLOR AVE STE A-47
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4474
Mailing Address - Country:US
Mailing Address - Phone:215-839-4004
Mailing Address - Fax:
Practice Address - Street 1:2750 TAYLOR AVE STE A-47
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4474
Practice Address - Country:US
Practice Address - Phone:215-908-9405
Practice Address - Fax:215-908-9405
Is Sole Proprietor?:No
Enumeration Date:2017-12-17
Last Update Date:2017-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist