Healthcare Provider Details

I. General information

NPI: 1508273699
Provider Name (Legal Business Name): GBO OTO GROUP PSC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CALLE CRISALIDA URB MUNOZ RIVERA
GUAYNABO PR
00969-3606
US

IV. Provider business mailing address

B29 URB LA COLINA
GUAYNABO PR
00969-3261
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-5238
  • Fax: 787-272-0824
Mailing address:
  • Phone: 787-720-5222
  • Fax: 787-789-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LIONEL FERNANDEZ LOPEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-617-6455