Healthcare Provider Details

I. General information

NPI: 1497112999
Provider Name (Legal Business Name): JOSE E OTERO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6367 ALVARADO CT STE 104
SAN DIEGO CA
92120-4914
US

IV. Provider business mailing address

6367 ALVARADO CT STE 104
SAN DIEGO CA
92120-4914
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-1211
  • Fax: 619-229-1141
Mailing address:
  • Phone: 619-229-1211
  • Fax: 619-229-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA30334
License Number StateCA

VIII. Authorized Official

Name: DR. JOSE ENRIQUE OTERO
Title or Position: OWNER
Credential: M.D.
Phone: 619-229-1211