Provider Demographics
NPI:1144265331
Name:COTTO ROSARIO, SORIVETT (OD)
Entity type:Individual
Prefix:DR
First Name:SORIVETT
Middle Name:
Last Name:COTTO ROSARIO
Suffix:
Gender:F
Credentials:OD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:N22 CALLE 15
Mailing Address - Street 2:URB. SANTA JUANA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2042
Mailing Address - Country:US
Mailing Address - Phone:787-703-0799
Mailing Address - Fax:787-905-7335
Practice Address - Street 1:LOS PRADOS PLAZA BLVD LOS PRADOS STE. 780
Practice Address - Street 2:CARR 156 SALIDA AGUAS BUENAS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-9533
Practice Address - Country:US
Practice Address - Phone:787-703-0799
Practice Address - Fax:787-905-7335
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU-63872Medicare UPIN
PR5-8160Medicare PIN