Healthcare Provider Details

I. General information

NPI: 1073324687
Provider Name (Legal Business Name): DANIEL S OTERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 SAN PEDRO DR NE BLDG B1
ALBUQUERQUE NM
87110-8903
US

IV. Provider business mailing address

3939 SAN PEDRO DR NE BLDG B1
ALBUQUERQUE NM
87110-8903
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-7600
  • Fax:
Mailing address:
  • Phone: 505-440-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: