Healthcare Provider Details

I. General information

NPI: 1174070932
Provider Name (Legal Business Name): PATRICIA REPOLLET OTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C9 CALLE 1 VISTA ALEGRE
AGUADILLA PR
00603
US

IV. Provider business mailing address

PO BOX 250016
AGUADILLA PR
00604-0016
US

V. Phone/Fax

Practice location:
  • Phone: 787-361-0542
  • Fax:
Mailing address:
  • Phone: 787-361-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: