Provider Demographics
NPI:1740879766
Name:COTTO, MARIA LOURDES
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LOURDES
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 1:10022 WINDING LAKE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5849
Mailing Address - Country:US
Mailing Address - Phone:939-539-8060
Mailing Address - Fax:
Practice Address - Street 1:7100 W COMMERCIAL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2147
Practice Address - Country:US
Practice Address - Phone:754-206-2953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9446732163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice