1225006307 NPI number — DR. JORGE A. OTERO-QUINTANA M.D.

Table of content: DR. JORGE A. OTERO-QUINTANA M.D. (NPI 1225006307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225006307 NPI number — DR. JORGE A. OTERO-QUINTANA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTERO-QUINTANA
Provider First Name:
JORGE
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225006307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ESTANCIAS DE TORTUGUERO
Provider Second Line Business Mailing Address:
629 TURIN ST.
Provider Business Mailing Address City Name:
VEGA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-0800
Provider Business Mailing Address Fax Number:
787-854-0808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO MEDICO I DR. PEDRO BLANCO LUGO
Provider Second Line Business Practice Location Address:
CARR. 2 KM. 47.7 SUITE 305
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-4665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-0800
Provider Business Practice Location Address Fax Number:
787-854-0808
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  10724 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6606086111 . This is a "MCS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6740082 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 89144 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 061503 . This is a "LCA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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