Healthcare Provider Details

I. General information

NPI: 1376453704
Provider Name (Legal Business Name): MARIANNE VICTORIA COTON HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 SYCAMORE DAIRY RD STE 109
FAYETTEVILLE NC
28303-3621
US

IV. Provider business mailing address

4011 SYCAMORE DAIRY RD STE 109
FAYETTEVILLE NC
28303-3621
US

V. Phone/Fax

Practice location:
  • Phone: 910-486-4311
  • Fax:
Mailing address:
  • Phone: 910-486-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1761
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: