Provider Demographics
NPI:1083834709
Name:PEREZ-OTERO, CARMEN I (RPH)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:I
Last Name:PEREZ-OTERO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B26 CALLE ANDORRA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-2808
Mailing Address - Country:US
Mailing Address - Phone:787-785-0312
Mailing Address - Fax:
Practice Address - Street 1:AVE DR.VEVE #101
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-785-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist