Provider Demographics
NPI:1023201142
Name:COUTTOLENC, LUZ MARIA
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:MARIA
Last Name:COUTTOLENC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6724 PINO REAL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2932
Mailing Address - Country:US
Mailing Address - Phone:915-584-1247
Mailing Address - Fax:915-832-0083
Practice Address - Street 1:6724 PINO REAL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2932
Practice Address - Country:US
Practice Address - Phone:915-584-1247
Practice Address - Fax:915-832-0083
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004635OtherPROVIDER NUMBER