Healthcare Provider Details

I. General information

NPI: 1740238609
Provider Name (Legal Business Name): CARLOS MANUEL OTERO RIVERA I M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/11/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 146 KM 27.4 BO. CORDILLERAS
CIALES PR
00638-0283
US

IV. Provider business mailing address

PO BOX 185
CIALES PR
00638-0185
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-3919
  • Fax: 787-871-2376
Mailing address:
  • Phone: 787-930-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8779
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: