Healthcare Provider Details

I. General information

NPI: 1851211783
Provider Name (Legal Business Name): GENESIS OTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB LEVITTOWN LAKES CALLE LAGO CERRILLO DR6 5TA SECC
TOA BAJA PR
00949
US

IV. Provider business mailing address

LEVITTOWN LAGO CERRILLO DR6 5TA SECC
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-245-0843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9124
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: