Provider Demographics
NPI:1982035861
Name:MEJIA OTERO, CAROLINA (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:MEJIA OTERO
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 1:3721 S HWY 27 STE B
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7919
Mailing Address - Country:US
Mailing Address - Phone:407-355-7759
Mailing Address - Fax:407-355-4987
Practice Address - Street 1:3721 S HWY 27 STE B
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7919
Practice Address - Country:US
Practice Address - Phone:407-355-7759
Practice Address - Fax:407-355-4987
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126877207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIP699ZMedicare PIN