1053509869 NPI number — ENRIQUE COTES

Table of content: ENRIQUE COTES (NPI 1053509869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053509869 NPI number — ENRIQUE COTES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COTES
Provider First Name:
ENRIQUE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053509869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20525 CENTER RIDGE RD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
ROCKY RIVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44116-3437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-895-5056
Provider Business Mailing Address Fax Number:
440-333-2935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15644 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44107-5622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-227-9839
Provider Business Practice Location Address Fax Number:
216-227-9867
Provider Enumeration Date:
10/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZC0006X , with the licence number:  35-061827 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0896900 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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