Healthcare Provider Details

I. General information

NPI: 1356553721
Provider Name (Legal Business Name): ROSEMARY W BUNTON COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 HAMPSTEAD LN
ORMOND BEACH FL
32174-1446
US

IV. Provider business mailing address

1204 HAMPSTEAD LN
ORMOND BEACH FL
32174-1446
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-0478
  • Fax:
Mailing address:
  • Phone: 386-677-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOTA9859
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: