Provider Demographics
NPI:1588666770
Name:FIGUEROA-OTERO, IVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:FIGUEROA-OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CALLE SAN JORGE
Mailing Address - Street 2:STE 407
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-3310
Mailing Address - Country:US
Mailing Address - Phone:787-728-1415
Mailing Address - Fax:787-728-1409
Practice Address - Street 1:252 CALLE SAN JORGE
Practice Address - Street 2:STE 407
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3310
Practice Address - Country:US
Practice Address - Phone:787-728-1415
Practice Address - Fax:787-728-1409
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR38392086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC78110Medicare UPIN