Provider Demographics
NPI:1508273699
Name:GBO OTO GROUP PSC.
Entity Type:Organization
Organization Name:GBO OTO GROUP PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-617-6455
Mailing Address - Street 1:B29 URB LA COLINA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3261
Mailing Address - Country:US
Mailing Address - Phone:787-720-5222
Mailing Address - Fax:787-789-7604
Practice Address - Street 1:2 CALLE CRISALIDA
Practice Address - Street 2:URB MUNOZ RIVERA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3606
Practice Address - Country:US
Practice Address - Phone:787-720-5238
Practice Address - Fax:787-272-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7851207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty