Provider Demographics
NPI:1477889038
Name:OTTO C CONCEPCION,MD.,P.A.
Entity Type:Organization
Organization Name:OTTO C CONCEPCION,MD.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:CESAR
Authorized Official - Last Name:CONCEPCION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-230-9980
Mailing Address - Street 1:6081 W 24TH AVE
Mailing Address - Street 2:APT 106
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6945
Mailing Address - Country:US
Mailing Address - Phone:786-230-9980
Mailing Address - Fax:
Practice Address - Street 1:6081 W 24TH AVE
Practice Address - Street 2:APT 106
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-6945
Practice Address - Country:US
Practice Address - Phone:646-641-5513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
FLME 103235282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care