Basic Information
| Provider Information | |||||||||
| NPI: | 1104541036 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COTTO | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | STEPHEN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12334 HAINES AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871124661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059109512 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | RAYMOND G MURPHY VA | ||||||||
| Address2: | 1501 SAN PEDRO DR SE | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052651711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2022 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 70092 | NM | Y | Nursing Service Providers | Registered Nurse |
No ID Information.