1992054159 NPI number — MS. CYNTHIA YVETTE STORY COTA

Table of content: MS. CYNTHIA YVETTE STORY COTA (NPI 1992054159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992054159 NPI number — MS. CYNTHIA YVETTE STORY COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STORY
Provider First Name:
CYNTHIA
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
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:
1992054159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 W BALDWYN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUEBLO WEST
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81007-2823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-547-0275
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 LAMKIN ST
Provider Second Line Business Practice Location Address:
UNIT 101B
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81003-3476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-353-7727
Provider Business Practice Location Address Fax Number:
719-253-7729
Provider Enumeration Date:
09/04/2012

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: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 29750521 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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