Provider Demographics
NPI:1467413328
Name:OTERO RIVERA, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:OTERO RIVERA
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 76- MERCEDITA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0076
Mailing Address - Country:US
Mailing Address - Phone:787-284-0574
Mailing Address - Fax:787-284-0574
Practice Address - Street 1:URB VALLE VERDE - PASEO REAL #1014
Practice Address - Street 2:SUITE 1
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3500
Practice Address - Country:US
Practice Address - Phone:787-284-0574
Practice Address - Fax:787-284-0574
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H82113Medicare UPIN
PR0020224Medicare ID - Type Unspecified