Healthcare Provider Details

I. General information

NPI: 1104541036
Provider Name (Legal Business Name): GERALD STEPHEN COTTO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-2682
US

IV. Provider business mailing address

2060 MAIN ST NE STE D
LOS LUNAS NM
87031-6368
US

V. Phone/Fax

Practice location:
  • Phone: 505-322-6687
  • Fax: 505-369-3406
Mailing address:
  • Phone: 505-910-3131
  • Fax: 505-581-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number70092
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number70092
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: