=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790050342
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIBEL RIVERA COTTO PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2012
-----------------------------------------------------
Last Update Date | 04/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARRETERA 734 KM 05 BO. ARENAS
-----------------------------------------------------
City | CIDRA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-633-2388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | B34 JARD DE BUENA VIS
-----------------------------------------------------
City | CAYEY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00736-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-633-2388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2083
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------