NPIMap

Organization Active NPI

Otologic PSC

  • Otology & Neurotology Physician
  • Mayaguez, PR
National Provider Identifier
1417095944
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otology & Neurotology PhysicianTaxonomy code 207YX0901X
License
11064 Issued in PR
Legal business name
OTOLOGIC PSC
Practice address
55E de Diego St.
Suite 105, CPR Professional BLDG.
Mayaguez, PR 00680
Phone
(787) 833-2155
Fax
(787) 833-2680
NPI assigned
Feb 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miguel A. Lasalle, MD
Title
Dueno
Phone
(787) 833-2155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otology & Neurotology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207YX0901X 11064 PR Primary

Addresses

Primary practice location

55E de Diego St.
Suite 105, CPR Professional BLDG.
Mayaguez, PR 00680

Mailing address

PO Box 6428
Mayaguez, PR 00781-6428
Phone (787) 833-2155

National Provider Directory

National Provider Directory
Tax ID family
Otologic PSC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417095944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6428",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "007816428",
            "telephone_number": "787-833-2155",
            "fax_number": "787-833-2680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55E DE DIEGO ST.",
            "address_2": "SUITE 105, CPR PROFESSIONAL BLDG.",
            "city": "MAYAGUEZ",
            "state": "PR",
            "postal_code": "00680",
            "telephone_number": "787-833-2155",
            "fax_number": "787-833-2680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTOLOGIC PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LASALLE",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "DUENO",
        "authorized_official_telephone_number": "787-833-2155",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "PR",
            "license": "11064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mayaguez, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.