Provider Demographics
NPI:1497112999
Name:JOSE E OTERO MD INC
Entity Type:Organization
Organization Name:JOSE E OTERO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-229-1211
Mailing Address - Street 1:6367 ALVARADO CT STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4914
Mailing Address - Country:US
Mailing Address - Phone:619-229-1211
Mailing Address - Fax:619-229-1141
Practice Address - Street 1:6367 ALVARADO CT STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4914
Practice Address - Country:US
Practice Address - Phone:619-229-1211
Practice Address - Fax:619-229-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA303342082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50132Medicare UPIN