Provider Demographics
NPI:1578544938
Name:OTERO-IGARAVIDEZ, YOLANDA (MD)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:OTERO-IGARAVIDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 51ST AVE N
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3507
Mailing Address - Country:US
Mailing Address - Phone:787-264-7174
Mailing Address - Fax:787-264-7174
Practice Address - Street 1:1 CALLE FERROCARRIL
Practice Address - Street 2:STE #2
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4038
Practice Address - Country:US
Practice Address - Phone:787-264-7174
Practice Address - Fax:787-264-7174
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H82112Medicare UPIN
20102Medicare ID - Type Unspecified