Healthcare Provider Details

I. General information

NPI: 1225006307
Provider Name (Legal Business Name): JORGE A. OTERO-QUINTANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIFICIO MEDICO I DR. PEDRO BLANCO LUGO CARR. 2 KM. 47.7 SUITE 305
MANATI PR
00674-4665
US

IV. Provider business mailing address

ESTANCIAS DE TORTUGUERO 629 TURIN ST.
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-0800
  • Fax: 787-854-0808
Mailing address:
  • Phone: 787-854-0800
  • Fax: 787-854-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10724
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier6606086111
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerMCS
# 2
Identifier6740082
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerHUMANA
# 3
Identifier89144
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerTRIPLE S
# 4
Identifier061503
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerLCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: