Provider Demographics
NPI:1598042871
Name:GALLOZA OTERO, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN CARLOS
Middle Name:
Last Name:GALLOZA 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 1:154 PASEO CIELO Y MAR
Mailing Address - Street 2:VISTA BAHIA
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-9756
Mailing Address - Country:US
Mailing Address - Phone:787-509-9725
Mailing Address - Fax:787-892-3810
Practice Address - Street 1:TORRE SAN VICENTE DE PAUL 1ST FLOOR
Practice Address - Street 2:CARR 2 KM 173
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0001
Practice Address - Country:US
Practice Address - Phone:787-892-1860
Practice Address - Fax:787-892-3810
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR02342081S0010X, 208100000X
PR210072081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GD142OtherBCBS
TX513232YKY3Medicare PIN