Provider Demographics
NPI:1295252708
Name:HERMOSILLA, ELIANA (COTA)
Entity type:Individual
Prefix:
First Name:ELIANA
Middle Name:
Last Name:HERMOSILLA
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 1:28881 SW 150TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2773
Mailing Address - Country:US
Mailing Address - Phone:786-985-9168
Mailing Address - Fax:
Practice Address - Street 1:9290 HAMMOCKS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1508
Practice Address - Country:US
Practice Address - Phone:786-558-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15884224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant