Healthcare Provider Details

I. General information

NPI: 1508002999
Provider Name (Legal Business Name): OTTO C CONCEPCION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 E 4TH AVE
HIALEAH FL
33013-2703
US

IV. Provider business mailing address

3855 E 4TH AVE
HIALEAH FL
33013-2703
US

V. Phone/Fax

Practice location:
  • Phone: 305-835-0438
  • Fax: 786-796-2721
Mailing address:
  • Phone: 305-835-0438
  • Fax: 786-796-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME103235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: