Provider Demographics
NPI:1871732990
Name:COTTO LAUREL GASTROENTEROLOGY CONSULTANTS PSC
Entity type:Organization
Organization Name:COTTO LAUREL GASTROENTEROLOGY CONSULTANTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ MCDOUGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-283-0804
Mailing Address - Street 1:PO BOX 801210
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1210
Mailing Address - Country:US
Mailing Address - Phone:787-283-0804
Mailing Address - Fax:787-761-5764
Practice Address - Street 1:TORRE HOSPITAL SAN CRISTOBAL
Practice Address - Street 2:SUITE 307
Practice Address - City:COTTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-283-0804
Practice Address - Fax:787-761-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16380207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24063Medicare PIN
PRI44136Medicare UPIN