Provider Demographics
NPI:1245797232
Name:COTTO, WILDALIS
Entity Type:Individual
Prefix:
First Name:WILDALIS
Middle Name:
Last Name:COTTO
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:HC 43 BOX 11938
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9232
Mailing Address - Country:US
Mailing Address - Phone:787-313-6085
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE BALDORIOTY ALTOS
Practice Address - Street 2:BARRIO PUEBLO
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-9232
Practice Address - Country:US
Practice Address - Phone:787-313-6085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3743103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty