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General NPI Number Information
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NPI Number | 1538569025
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Entity Type | Individual
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Provider Name | DR. KASSANDRA L OTERO
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Gender | Female
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 12001 SOUTHERN BLVD
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-4994
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Country | US
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Telephone | 561-784-7407
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Fax |
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Provider Business Mailing Address
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Address Line | 134 VAN GOGH WAY
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-1580
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Country | US
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Telephone | 561-236-9687
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS52346
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License Number State | FL
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