Provider Demographics
NPI:1295412443
Name:FANO COTO, LEYDY
Entity type:Individual
Prefix:
First Name:LEYDY
Middle Name:
Last Name:FANO COTO
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 1:5461 W 24TH AVE APT 62
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4706
Mailing Address - Country:US
Mailing Address - Phone:786-914-0743
Mailing Address - Fax:
Practice Address - Street 1:5461 W 24TH AVE APT 62
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4706
Practice Address - Country:US
Practice Address - Phone:786-914-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-276905106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician