Provider Demographics
NPI:1073523080
Name:OTERO, JUAN ESTEBAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ESTEBAN
Last Name:OTERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 AVE MONTE CARLO APT 187
Mailing Address - Street 2:PORTAL DE LA REINA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-5749
Mailing Address - Country:US
Mailing Address - Phone:787-762-9287
Mailing Address - Fax:787-762-9287
Practice Address - Street 1:11 CALLE MARGINAL
Practice Address - Street 2:ROBERTO CLEMENTE AVE.
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-6328
Practice Address - Country:US
Practice Address - Phone:787-762-9287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU86843Medicare UPIN
PR90432Medicare ID - Type UnspecifiedPROVIDER#