Healthcare Provider Details

I. General information

NPI: 1902414477
Provider Name (Legal Business Name): MEDICINA FAMILIAR OTOAO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 CALLE FERNANDO L GARCIA
UTUADO PR
00641-3035
US

IV. Provider business mailing address

53 CALLE BETANCES
UTUADO PR
00641-2859
US

V. Phone/Fax

Practice location:
  • Phone: 787-615-8365
  • Fax:
Mailing address:
  • Phone: 787-615-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASTRID L ARCE RAMOS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-615-8365