Provider Demographics
NPI:1033176763
Name:OTERO, JOSE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6367 ALVARADO CT
Mailing Address - Street 2:#104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-229-1211
Mailing Address - Fax:619-229-1141
Practice Address - Street 1:6367 ALVARADO CT
Practice Address - Street 2:#104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:619-229-1211
Practice Address - Fax:619-229-1141
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA303342082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB249129OtherPTAN FOR GROUP
CACB249130OtherPTAN
CAB50132Medicare UPIN