Healthcare Provider Details

I. General information

NPI: 1679086979
Provider Name (Legal Business Name): CINTHIA ELIZABETH OTERO WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E COLUMBIA ST STE 201
LONG BEACH CA
90806-1620
US

IV. Provider business mailing address

701 E 28TH ST STE 412
LONG BEACH CA
90806-2790
US

V. Phone/Fax

Practice location:
  • Phone: 844-822-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95007970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: