Healthcare Provider Details

I. General information

NPI: 1841300308
Provider Name (Legal Business Name): CARMEN SOCORRO OTERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESQUINA BALDORIOTY CALLE CELIS JUAN R GARZOT #33 OCIC 2
NAGUABO PR
00718
US

IV. Provider business mailing address

AZABACH C-50 MANSIONES DE SANTA BARBARA
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-874-0460
  • Fax:
Mailing address:
  • Phone: 787-743-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12915
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: