Provider Demographics
NPI:1891422044
Name:ROJAS TORRES, OTTONIEL
Entity Type:Individual
Prefix:
First Name:OTTONIEL
Middle Name:
Last Name:ROJAS TORRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 AVE LAURO PINERO
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-2732
Mailing Address - Country:US
Mailing Address - Phone:787-885-8080
Mailing Address - Fax:
Practice Address - Street 1:190 AVE LAURO PINERO
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2732
Practice Address - Country:US
Practice Address - Phone:787-885-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant