Provider Demographics
NPI:1225473739
Name:ORRACA-GOTAY, ANTONIO L
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:L
Last Name:ORRACA-GOTAY
Suffix:
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 11577
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2677
Mailing Address - Country:US
Mailing Address - Phone:787-723-5017
Mailing Address - Fax:787-723-5015
Practice Address - Street 1:1492 AVE PONCE DE LEON
Practice Address - Street 2:EDIF. CENTRO EUROPA 717
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-723-5017
Practice Address - Fax:787-723-5015
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19519207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty