Basic Information
| Provider Information | |||||||||
| NPI: | 1972950632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAM RUBIO | ||||||||
| FirstName: | OTAMI | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7705 W 29TH WAY APT 101 | ||||||||
| Address2: | |||||||||
| City: | HIALEAH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330187221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862533746 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14335 SW 120TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331867296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059678074 | ||||||||
| FaxNumber: | 3059678302 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2016 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106E00000X | 0-20-11302 | FL | N | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.