Provider Demographics
NPI:1447616024
Name:OTERO, JOSE (8616)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:OTERO
Suffix:
Gender:M
Credentials:8616
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:QUINTAS DEL RIO D-12
Mailing Address - Street 2:CAMINO DEL CHALET
Mailing Address - City:BAYAMON
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00961
Mailing Address - Country:UM
Mailing Address - Phone:787-607-5818
Mailing Address - Fax:
Practice Address - Street 1:QUINTAS DEL RIO D-12
Practice Address - Street 2:CAMINO DEL CHALET
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00961
Practice Address - Country:UM
Practice Address - Phone:787-607-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8616183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician