Provider Demographics
NPI:1942523758
Name:OTERO MALDONADO, IRIS (MD)
Entity Type:Individual
Prefix:
First Name:IRIS
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 1:4825 BAY HERON PL APT 509
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-2926
Mailing Address - Country:US
Mailing Address - Phone:787-554-9484
Mailing Address - Fax:
Practice Address - Street 1:1808 SANTA ISABEL
Practice Address - Street 2:URB. EL PILAR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-554-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7376207R00000X
FLACN1032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR$$$$$$$$$OtherSEGURO SOCIAL