Provider Demographics
NPI:1841300308
Name:OTERO, CARMEN SOCORRO (MD)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:SOCORRO
Last Name: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:AZABACH C-50 MANSIONES DE SANTA BARBARA
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-743-2491
Mailing Address - Fax:
Practice Address - Street 1:ESQUINA BALDORIOTY CALLE CELIS
Practice Address - Street 2:JUAN R GARZOT #33 OCIC 2
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-874-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12915208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics