Provider Demographics
NPI:1992377089
Name:COTTO MORENO, DENISSE MARIE
Entity type:Individual
Prefix:
First Name:DENISSE
Middle Name:MARIE
Last Name:COTTO MORENO
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 1:769 PLATYPUS CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4324
Mailing Address - Country:US
Mailing Address - Phone:321-437-2748
Mailing Address - Fax:
Practice Address - Street 1:769 PLATYPUS CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4324
Practice Address - Country:US
Practice Address - Phone:321-437-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL005620000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health