MEDICARE: ANTHONY OTERO FALERO CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	120395	PR
2	367500000X	Certified Registered Nurse Anesthetist	11007459	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083104905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY OTERO FALERO CRNA

Provider Business Mailing Address
First Line	:	258 JACKSON LOOP
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32724-3251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 STERTHAUS DR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5133
Country	:	US
Telephone Number	:	787-553-0831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2018
Last Update Date	:	05/31/2023

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