Provider Demographics
NPI:1114655784
Name:CONSULTORIO MEDICINA DE FAMILIA, INC.
Entity Type:Organization
Organization Name:CONSULTORIO MEDICINA DE FAMILIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:OTERO RIVERA
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:787-871-3919
Mailing Address - Street 1:25 CARR 149 UNIT 185
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-3610
Mailing Address - Country:US
Mailing Address - Phone:787-871-3919
Mailing Address - Fax:
Practice Address - Street 1:CARR. 146 KM 27.4
Practice Address - Street 2:BO. CORDILLERA
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638
Practice Address - Country:US
Practice Address - Phone:787-871-3919
Practice Address - Fax:787-871-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1234567891OtherNPI