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General NPI Number Information
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NPI Number | 1790199271
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Entity Type | Individual
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Provider Name | ILEANA VAZQUEZ OTERO MD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 100 CARR 165 STE 406
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City | GUAYNABO
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State | PR
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Zip | 00968-8050
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Country | US
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Telephone | 939-945-8335
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Fax | 939-945-8332
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Provider Business Mailing Address
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Address Line | 55 CALLE CASALS
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City | GUAYNABO
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State | PR
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Zip | 00969-1004
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 19,602
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License Number State | PR
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