1235320086 NPI number — DR. WILMA L COTTO OYOLA MD

Table of content: DR. WILMA L COTTO OYOLA MD (NPI 1235320086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235320086 NPI number — DR. WILMA L COTTO OYOLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COTTO OYOLA
Provider First Name:
WILMA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COTTO
Provider Other First Name:
WILMA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235320086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1353 AVE LUIS VIGOREAUX
Provider Second Line Business Mailing Address:
PMB 633
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00966-2715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-798-5998
Provider Business Mailing Address Fax Number:
787-780-0971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE SANTA CRUZ, EDIF. MEDICO SANTA CRUZ #73
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-7052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-5998
Provider Business Practice Location Address Fax Number:
787-780-0971
Provider Enumeration Date:
08/07/2007

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: 207RG0100X , with the licence number:  MD.025265 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 14840 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1421201 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00270331 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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