Provider Demographics
NPI:1699944579
Name:COCUZZI, JANE OLTROGGE (RD, LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:OLTROGGE
Last Name:COCUZZI
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E HARRIS AVE
Mailing Address - Street 2:SHANNON MEDICAL CENTER
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-5904
Mailing Address - Country:US
Mailing Address - Phone:325-657-5246
Mailing Address - Fax:325-657-5453
Practice Address - Street 1:120 E HARRIS AVE
Practice Address - Street 2:SHANNON MEDICAL CENTER
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5904
Practice Address - Country:US
Practice Address - Phone:325-657-5246
Practice Address - Fax:325-657-5453
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT05872133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered