Provider Demographics
NPI:1992286686
Name:FERMIN COTTO, GAMALIS ESTHER
Entity type:Individual
Prefix:MS
First Name:GAMALIS
Middle Name:ESTHER
Last Name:FERMIN COTTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 AVE SAN IGNACIO
Mailing Address - Street 2:BOX 101
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4753
Mailing Address - Country:US
Mailing Address - Phone:787-423-8080
Mailing Address - Fax:
Practice Address - Street 1:METRO MEDICAL CENTER
Practice Address - Street 2:TORRE A-102
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-423-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5923103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5923OtherLICENSE