Healthcare Provider Details

I. General information

NPI: 1295650836
Provider Name (Legal Business Name): ILIANA OTERO DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 CALLE COLL Y TOSTE
SAN JUAN PR
00918-4026
US

IV. Provider business mailing address

PASEO DEL PRADO 3 CALLE EUCALIPTO
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-368-9067
  • Fax:
Mailing address:
  • Phone: 787-368-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number708
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: