1033210950 NPI number — CARMEN WALESKA COTTO M.D.

Table of content: MARISA CHRISTINE CAPONI (NPI 1831988948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033210950 NPI number — CARMEN WALESKA COTTO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COTTO
Provider First Name:
CARMEN
Provider Middle Name:
WALESKA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1033210950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2625 AVE HOSTOS STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYAGUEZ
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00682-6326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-565-7375
Provider Business Mailing Address Fax Number:
787-960-2223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 JUAN L. RAMOS
Provider Second Line Business Practice Location Address:
FRONTERAS
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-565-7375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2006

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: 208000000X , with the licence number:  16479 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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