Provider Demographics
NPI:1659705366
Name:DE LA TORRE, ZELMA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:ZELMA
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3017
Mailing Address - Country:US
Mailing Address - Phone:305-282-4337
Mailing Address - Fax:
Practice Address - Street 1:4464 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3358
Practice Address - Country:US
Practice Address - Phone:786-512-3874
Practice Address - Fax:188-859-5317
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 12654224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003323500Medicaid