Provider Demographics
NPI:1952076168
Name:COTTO ORTIZ, KARYAN IVETTE
Entity Type:Individual
Prefix:
First Name:KARYAN
Middle Name:IVETTE
Last Name:COTTO ORTIZ
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 1:2930 BOATING BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4540
Mailing Address - Country:US
Mailing Address - Phone:407-684-9185
Mailing Address - Fax:
Practice Address - Street 1:816 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3371
Practice Address - Country:US
Practice Address - Phone:321-805-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician