Provider Demographics
NPI:1043092471
Name:RIVERA OTERO, GLORIALYS
Entity Type:Individual
Prefix:
First Name:GLORIALYS
Middle Name:
Last Name:RIVERA OTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1115
Mailing Address - Country:US
Mailing Address - Phone:787-387-2757
Mailing Address - Fax:
Practice Address - Street 1:BO QUEBRADILLAS, SECTOR EL FARALLON, CARR 773 KM-2.2
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1115
Practice Address - Country:US
Practice Address - Phone:787-387-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46141390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program