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General NPI Number Information
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NPI Number | 1104541036
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Entity Type | Individual
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Provider Name | GERALD STEPHEN COTTO FNP
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Gender | Male
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 6330 RIVERSIDE PLAZA LN NW STE 100
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-2682
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Country | US
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Telephone | 505-322-6687
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Fax | 505-369-3406
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Provider Business Mailing Address
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Address Line | 2060 MAIN ST NE STE D
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City | LOS LUNAS
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State | NM
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Zip | 87031-6368
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Country | US
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Telephone | 505-910-3131
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Fax | 505-581-3314
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 70092
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 70092
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License Number State | NM
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