=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164660759
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDNA I OTERO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2009
-----------------------------------------------------
Last Update Date | 02/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVE. LUIS MUNOZ RIVERA 91
-----------------------------------------------------
City | SANTA ISABEL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-845-1188
-----------------------------------------------------
Fax | 787-845-1188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1195
-----------------------------------------------------
City | SANTA ISABEL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00757-1195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-648-5514
-----------------------------------------------------
Fax | 787-845-1188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 17041
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------