Healthcare Provider Details

I. General information

NPI: 1396203998
Provider Name (Legal Business Name): TAYRA I COTTO FEBLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B4 URBANIZACION VILLA NITZA 1
MANATI PR
00674-0067
US

IV. Provider business mailing address

PO BOX 979
MANATI PR
00674-0979
US

V. Phone/Fax

Practice location:
  • Phone: 787-628-7650
  • Fax:
Mailing address:
  • Phone: 787-628-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number021220
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: