Healthcare Provider Details

I. General information

NPI: 1205997244
Provider Name (Legal Business Name): SUSAN E. OTERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN EARLY OTERO MD

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 LITTLE FALLS DR
WILMINGTON DE
19808-1674
US

IV. Provider business mailing address

3746 FOOTHILL BLVD STE B140
GLENDALE CA
91214-1740
US

V. Phone/Fax

Practice location:
  • Phone: 310-445-5999
  • Fax:
Mailing address:
  • Phone: 310-445-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD14270
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC1-0025325
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: