Provider Demographics
NPI:1477934115
Name:OTERO-DEMARY, MILAGROS
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:
Last Name:OTERO-DEMARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1121
Mailing Address - Country:US
Mailing Address - Phone:407-247-6700
Mailing Address - Fax:407-391-9035
Practice Address - Street 1:705 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1121
Practice Address - Country:US
Practice Address - Phone:407-247-6700
Practice Address - Fax:407-391-9035
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist