Healthcare Provider Details

I. General information

NPI: 1144265331
Provider Name (Legal Business Name): SORIVETT COTTO ROSARIO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOS PRADOS PLAZA BLVD LOS PRADOS STE. 780 CARR 156 SALIDA AGUAS BUENAS
CAGUAS PR
00727-9533
US

IV. Provider business mailing address

N22 CALLE 15 URB. SANTA JUANA
CAGUAS PR
00725-2042
US

V. Phone/Fax

Practice location:
  • Phone: 787-703-0799
  • Fax: 787-905-7335
Mailing address:
  • Phone: 787-703-0799
  • Fax: 787-905-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number405
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: