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General NPI Number Information
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NPI Number | 1336404375
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Entity Type | Organization
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Legal Business Name | GRUPO MEDICO OTOAO, PSC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | CARR 455 KM 2.0 BO QUEBRADA
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City | CAMUY
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State | PR
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Zip | 00627
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Country | US
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Telephone | 787-938-8447
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3190
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City | ARECIBO
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State | PR
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Zip | 00613-3190
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Country | US
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Telephone | 787-938-8447
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Fax |
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Authorized Official
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Title or Position | MD
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Name | JOSE M RIVERA
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Credential |
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Telephone | 787-938-8447
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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 | 15206
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 15206
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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