Healthcare Provider Details

I. General information

NPI: 1174442982
Provider Name (Legal Business Name): BROAD SPECTRUM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS
MAYAGUEZ PR
00682-1560
US

IV. Provider business mailing address

3101 CALLE LAS PALMERAS
CABO ROJO PR
00623-4246
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIANA ROLAN OTERO
Title or Position: PRESIDENT
Credential: MD
Phone: 702-481-8087