Healthcare Provider Details

I. General information

NPI: 1730385980
Provider Name (Legal Business Name): HUGO TINOCO COTAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PURDUE DR
FAYETTEVILLE NC
28304-3674
US

IV. Provider business mailing address

995 EASTMAN RD
FAYETTEVILLE NC
28314-5167
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-5000
  • Fax:
Mailing address:
  • Phone: 910-728-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5821
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: