Provider Demographics
NPI:1093218802
Name:OTALORA ROJAS, LILIAN ASTRID (MD)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:ASTRID
Last Name:OTALORA ROJAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 2105
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5224
Practice Address - Country:US
Practice Address - Phone:904-292-4111
Practice Address - Fax:904-292-4080
Is Sole Proprietor?:No
Enumeration Date:2018-03-18
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME160963207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology