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General NPI Number Information
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NPI Number | 1518057983
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Entity Type | Individual
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Provider Name | JULIO C OTAZO M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 801 N BEDELL AVE
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City | DEL RIO
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State | TX
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Zip | 78840-4112
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Country | US
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Telephone | 830-703-1745
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Fax | 830-774-4599
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Provider Business Mailing Address
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Address Line | 8401 DATAPOINT DR STE 600 P. O. BOX 29441
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5907
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Country | US
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Telephone | 210-616-7796
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Fax | 210-616-7799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G6083
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License Number State | TX
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