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General NPI Number Information
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NPI Number | 1174353734
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Entity Type | Organization
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Legal Business Name | BORINQUEN UROLOGY LLC
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | METROPOLITAN OFFICE BUILDING 153 CALLE JOSE DE DIEGO
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City | ARECIBO
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State | PR
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Zip | 00612
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Country | US
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Telephone | 215-662-2891
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 145200
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City | ARECIBO
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State | PR
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Zip | 00614-5200
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | UROLOGIST (CEO)
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Name | VICTOR E OTANO-RIVERA
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Credential | MD
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Telephone | 267-624-3578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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