MEDICARE: MRS. CRYSTAL OTERO-GRIFFITH CNP

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	363L00000X	Nurse Practitioner	61521	NM
2	363LF0000X	Family Nurse Practitioner	61521	NM

General Provider Information

NPI Number	:	1750997391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL OTERO-GRIFFITH CNP

Provider Business Mailing Address
First Line	:	8227 CALLE PRIMERA NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-5392
Country	:	US
Telephone Number	:	505-417-1413
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 5TH ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-1312
Country	:	US
Telephone Number	:	505-417-1413
Fax Number	:

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

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	07/17/2025

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