Healthcare Provider Details

I. General information

NPI: 1629648514
Provider Name (Legal Business Name): MAHE OTERO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE 403
HIALEAH FL
33016-1811
US

IV. Provider business mailing address

7100 W 20TH AVE STE 403
HIALEAH FL
33016-1811
US

V. Phone/Fax

Practice location:
  • Phone: 786-785-5581
  • Fax:
Mailing address:
  • Phone: 786-785-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: