Provider Demographics
NPI:1740238609
Name:OTERO RIVERA, CARLOS MANUEL I (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
Last Name:OTERO RIVERA
Suffix:I
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:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-0185
Mailing Address - Country:US
Mailing Address - Phone:787-930-8017
Mailing Address - Fax:
Practice Address - Street 1:CARR. 146 KM 27.4
Practice Address - Street 2:BO. CORDILLERAS
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-0283
Practice Address - Country:US
Practice Address - Phone:787-871-3919
Practice Address - Fax:787-871-2376
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038417700Medicaid