Healthcare Provider Details

I. General information

NPI: 1407851959
Provider Name (Legal Business Name): JOSE E OTERO GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE GENERAL VALERO STE 201
FAJARDO PR
00738-3988
US

IV. Provider business mailing address

410 AVE GENERAL VALERO STE 201
FAJARDO PR
00738-3988
US

V. Phone/Fax

Practice location:
  • Phone: 787-655-5062
  • Fax:
Mailing address:
  • Phone: 787-655-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number12317
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: