Organization
SLP360, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIARA L COTTLE (PRESIDENT)
(786) 439-5550
Entity
Organization
Contact information
Practice address
2814 LINCOLN ST, HOLLYWOOD, FL 33020-3834
(786) 439-5550
(888) 335-8617
Mailing address
2814 LINCOLN ST, HOLLYWOOD, FL 33020
(786) 439-5550
(888) 335-8617
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11982414
CAQH
FL
05
—
891202501
—
FL
Enumeration date
09/25/2009
Last updated
09/06/2023
Update your record
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