Healthcare Provider Details

I. General information

NPI: 1992286686
Provider Name (Legal Business Name): MS. GAMALIS ESTHER FERMIN COTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METRO MEDICAL CENTER TORRE A-102
BAYAMON PR
00959
US

IV. Provider business mailing address

1500 AVE SAN IGNACIO BOX 101
SAN JUAN PR
00921-4753
US

V. Phone/Fax

Practice location:
  • Phone: 787-423-8080
  • Fax:
Mailing address:
  • Phone: 787-423-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5923
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: