Provider Demographics
NPI:1245817725
Name:COTS MEDICAL GROUP CORP
Entity type:Organization
Organization Name:COTS MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-218-1628
Mailing Address - Street 1:7500 SW 8TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4400
Mailing Address - Country:US
Mailing Address - Phone:786-558-9009
Mailing Address - Fax:786-332-4361
Practice Address - Street 1:7500 SW 8TH ST STE 202
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33144-4400
Practice Address - Country:US
Practice Address - Phone:786-558-9009
Practice Address - Fax:786-332-4361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113585800Medicaid