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NPI Code Detail

MEDICARE: DR. INELISSE OTERO-DIAZ M.D.

MEDICARE: DR. INELISSE OTERO-DIAZ M.D.
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
1207R00000XInternal Medicine PhysicianME128511FL

Other Identifiers

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

General Provider Information

NPI Number : 1952735862
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. INELISSE OTERO-DIAZ M.D.
Provider Business Mailing Address
First Line : 2751 NW 70TH BLVD
Second Line :
City : BOCA RATON
State : FL
Zip : 33496-3529
Country : US
Telephone Number : 787-633-5616
Fax Number :
Provider Business Practice Location Address
First Line : 1475 W 49TH PL
Second Line :
City : HIALEAH
State : FL
Zip : 33012-3113
Country : US
Telephone Number : 305-558-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2013
Last Update Date : 05/20/2024

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