Provider Demographics
NPI:1750344602
Name:DIAZ-OTERO, HEBERTO R (MD)
Entity type:Individual
Prefix:DR
First Name:HEBERTO
Middle Name:R
Last Name:DIAZ-OTERO
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:PO BOX 250321
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0321
Mailing Address - Country:US
Mailing Address - Phone:787-868-5111
Mailing Address - Fax:787-868-2305
Practice Address - Street 1:CMSCOOPERATIVO ROAD115 KM 24.6
Practice Address - Street 2:OFFICE #3
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0000
Practice Address - Country:US
Practice Address - Phone:787-868-5111
Practice Address - Fax:787-868-2305
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6290207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77564Medicare UPIN