Provider Demographics
NPI:1760430474
Name:CORTES-PADILLA, CONSUELO
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:CORTES-PADILLA
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 1:4772 SW 154TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4426
Mailing Address - Country:US
Mailing Address - Phone:305-281-6505
Mailing Address - Fax:
Practice Address - Street 1:14335 SW 120TH ST
Practice Address - Street 2:113
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7294
Practice Address - Country:US
Practice Address - Phone:305-382-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT3078225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT3078OtherOCCUPATIONAL THERAPIST