Provider Demographics
NPI:1518902303
Name:RAFAEL F OTERO, PHD, INC
Entity Type:Organization
Organization Name:RAFAEL F OTERO, PHD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES./PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-838-3711
Mailing Address - Street 1:5425 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1662
Mailing Address - Country:US
Mailing Address - Phone:903-838-3711
Mailing Address - Fax:903-838-8879
Practice Address - Street 1:5425 PLAZA DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1662
Practice Address - Country:US
Practice Address - Phone:903-838-3711
Practice Address - Fax:903-838-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3031103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80433OtherAR BC/BS
TX80433OtherAR BC/BS
TXR58294Medicare UPIN
AR5F578Medicare PIN