Provider Demographics
NPI:1487626875
Name:SARRIERA-ROCAFORT, OTTO A (MD, MRO)
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:A
Last Name:SARRIERA-ROCAFORT
Suffix:
Gender:M
Credentials:MD, MRO
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 19346
Mailing Address - Street 2:FDEZ. JUNCOS STA.
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1346
Mailing Address - Country:US
Mailing Address - Phone:787-226-5387
Mailing Address - Fax:787-793-6538
Practice Address - Street 1:1534 CALLE 10 SO
Practice Address - Street 2:CAPARRA TERRACE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1527
Practice Address - Country:US
Practice Address - Phone:787-226-5387
Practice Address - Fax:787-793-6538
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7919208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80155OtherTRIPLE-S PIN
PR6220017OtherHUMANA INSURANCE PIN
PR062616OtherCRUZ AZUL DE PR PIN
PR80155OtherTRIPLE-S PIN
PR062616OtherCRUZ AZUL DE PR PIN