Provider Demographics
NPI:1174633267
Name:COTTO, ROALBA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROALBA
Middle Name:
Last Name:COTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MIRAMELINDA
Mailing Address - Street 2:SABANERA
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-599-1843
Mailing Address - Fax:787-739-9663
Practice Address - Street 1:406 MIRAMELINDA
Practice Address - Street 2:SABANERA
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-754-4244
Practice Address - Fax:787-739-9663
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9720208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF07642Medicare UPIN
PR0081946Medicare ID - Type UnspecifiedMEDICARE