Healthcare Provider Details

I. General information

NPI: 1871590968
Provider Name (Legal Business Name): JUAN R OTERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONSOLIDATED MALL AVE GAUTIER BENITEZ SUITE C-28
CAGUAS PR
00725-0000
US

IV. Provider business mailing address

PO BOX 9236
CAGUAS PR
00726-9236
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-7057
  • Fax: 787-746-7057
Mailing address:
  • Phone: 787-746-7057
  • Fax: 787-746-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number8189
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: