Provider Demographics
NPI:1023192572
Name:DE LA COTERA, LYNDA KERSTIN (MAMS)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:KERSTIN
Last Name:DE LA COTERA
Suffix:
Gender:F
Credentials:MAMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2115
Mailing Address - Country:US
Mailing Address - Phone:708-488-0265
Mailing Address - Fax:
Practice Address - Street 1:211 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2115
Practice Address - Country:US
Practice Address - Phone:708-488-0265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital