Healthcare Provider Details

I. General information

NPI: 1245465269
Provider Name (Legal Business Name): MR. GILBERT OTANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 W 16TH AVE STE 5
HIALEAH FL
33012-7005
US

IV. Provider business mailing address

3825 W 16TH AVE STE 5
HIALEAH FL
33012-7005
US

V. Phone/Fax

Practice location:
  • Phone: 305-859-7400
  • Fax: 305-858-1100
Mailing address:
  • Phone: 305-859-7400
  • Fax: 305-858-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: