Healthcare Provider Details

I. General information

NPI: 1093372369
Provider Name (Legal Business Name): MARIANA DEL CARMEN ROLAN OTERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS
MAYAGUEZ PR
00682-1560
US

IV. Provider business mailing address

401 AVE HOSTOS
MAYAGUEZ PR
00680-1518
US

V. Phone/Fax

Practice location:
  • Phone: 787-652-9200
  • Fax:
Mailing address:
  • Phone: 787-652-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number23265
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: