Provider Demographics
NPI:1013126382
Name:OTERO-HERRMANN, GUILLERMO ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ROBERTO
Last Name:OTERO-HERRMANN
Suffix:
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:#132 WINSTON CHURCHILL AVENUE
Mailing Address - Street 2:MSC 742
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6023
Mailing Address - Country:US
Mailing Address - Phone:787-755-8858
Mailing Address - Fax:787-764-8717
Practice Address - Street 1:1058 CALLE BRUMBAUGH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2914
Practice Address - Country:US
Practice Address - Phone:787-765-5757
Practice Address - Fax:787-764-8717
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5419208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics