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NPI Code Detail

MEDICARE: LISSETTE ALEXANDRA OTERO NP

MEDICARE: LISSETTE ALEXANDRA OTERO NP
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
1363LA2200XAdult Health Nurse Practitioner311049NY

General Provider Information

NPI Number : 1255037065
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISSETTE ALEXANDRA OTERO NP
Provider Business Mailing Address
First Line : PO BOX 746087
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6087
Country : US
Telephone Number : 773-352-1515
Fax Number :
Provider Business Practice Location Address
First Line : 4405 BROADWAY
Second Line :
City : NEW YORK
State : NY
Zip : 10040-4014
Country : US
Telephone Number : 212-740-2020
Fax Number : 646-666-0280
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2023
Last Update Date : 04/13/2026

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