Provider Demographics
NPI:1255969317
Name:CUESTA, GABRIEL BERNARDO (COTA)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:BERNARDO
Last Name:CUESTA
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15354 SW 36TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4701
Mailing Address - Country:US
Mailing Address - Phone:786-509-0924
Mailing Address - Fax:
Practice Address - Street 1:15354 SW 36TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4701
Practice Address - Country:US
Practice Address - Phone:786-509-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17168224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant