Provider Demographics
NPI:1477040996
Name:GARBAYO OTANO, ENRIQUE (SA-C)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:GARBAYO OTANO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6686 SW 103RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1314
Mailing Address - Country:US
Mailing Address - Phone:786-451-4551
Mailing Address - Fax:
Practice Address - Street 1:6686 SW 103RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1314
Practice Address - Country:US
Practice Address - Phone:786-451-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15-268246ZC0007X
FLRN9650944163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant