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General NPI Number Information
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NPI Number | 1952282071
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Entity Type | Organization
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Legal Business Name | SKIN 2 WITHIN LLC
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Dates
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Enumeration Date | 09/08/2025
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Last Update Date | 09/08/2025
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Provider Practice Location 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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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 | 505-910-3131
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Authorized Official
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Title or Position | FNP-C
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Name | MR. GERALD STEPHEN COTTO
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Credential |
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Telephone | 505-910-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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