Provider Demographics
NPI:1467167502
Name:OTOMAN MUSTAFA, DAOUD SR
Entity type:Individual
Prefix:DR
First Name:DAOUD
Middle Name:
Last Name:OTOMAN MUSTAFA
Suffix:SR
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:PO BOX 1749
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-8749
Mailing Address - Country:US
Mailing Address - Phone:787-361-2330
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE PALMA # 614
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4526
Practice Address - Country:US
Practice Address - Phone:787-361-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2024-11-22
Deactivation Date:2024-04-19
Deactivation Code:
Reactivation Date:2024-06-03
Provider Licenses
StateLicense IDTaxonomies
PR23765208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice