Provider Demographics
NPI:1922112838
Name:COTTO, JUAN J (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:COTTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PARQUE MEDICI
Mailing Address - Street 2:PASEO DEL PARQUE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6514
Mailing Address - Country:US
Mailing Address - Phone:787-760-8830
Mailing Address - Fax:
Practice Address - Street 1:39 PARQUE MEDICI
Practice Address - Street 2:PASEO DEL PARQUE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6514
Practice Address - Country:US
Practice Address - Phone:787-760-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7245208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029018Medicare ID - Type Unspecified