Provider Demographics
NPI:1205078755
Name:CINCO, MARIA VICTORIA GOMEZ (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARIA VICTORIA
Middle Name:GOMEZ
Last Name:CINCO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARIA VICTORIA
Other - Middle Name:AUSTRIA
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 CLARKE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-6202
Mailing Address - Country:US
Mailing Address - Phone:917-202-3693
Mailing Address - Fax:718-979-1083
Practice Address - Street 1:222 CLARKE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-6202
Practice Address - Country:US
Practice Address - Phone:917-202-3693
Practice Address - Fax:718-979-1083
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005606225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist