Healthcare Provider Details

I. General information

NPI: 1023192572
Provider Name (Legal Business Name): LYNDA KERSTIN DE LA COTERA M.A.M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 FRANKLIN AVE
RIVER FOREST IL
60305-2115
US

IV. Provider business mailing address

211 FRANKLIN AVE
RIVER FOREST IL
60305-2115
US

V. Phone/Fax

Practice location:
  • Phone: 708-488-0265
  • Fax:
Mailing address:
  • Phone: 708-488-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: