Provider Demographics
NPI:1649420480
Name:OTERO MALDONADO, MARIELYS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIELYS
Middle Name:
Last Name:OTERO MALDONADO
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 1:245 CALLE MONTE CARLO
Mailing Address - Street 2:URB. MONACO 3
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-6674
Mailing Address - Country:US
Mailing Address - Phone:787-415-0680
Mailing Address - Fax:
Practice Address - Street 1:245 CALLE MONTE CARLO
Practice Address - Street 2:URB. MONACO 3
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-6674
Practice Address - Country:US
Practice Address - Phone:787-415-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17281207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease