Provider Demographics
NPI:1386445096
Name:MOGAVE LLC
Entity type:Organization
Organization Name:MOGAVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-460-8328
Mailing Address - Street 1:31 COBANA ST
Mailing Address - Street 2:URB LADERAS DE SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9314
Mailing Address - Country:US
Mailing Address - Phone:787-460-8328
Mailing Address - Fax:787-474-8328
Practice Address - Street 1:CARR 165 KM 0
Practice Address - Street 2:SUITE 1010 CITY VIEW PLAZA II
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-0096
Practice Address - Country:US
Practice Address - Phone:787-460-8328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty