Provider Demographics
NPI:1619972981
Name:ACOSTA-OTERO, ANDRES A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:A
Last Name:ACOSTA-OTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CALLE CORNELL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4124
Mailing Address - Country:US
Mailing Address - Phone:787-764-9841
Mailing Address - Fax:787-274-0783
Practice Address - Street 1:1056 AVE MUNOZ RIVERA
Practice Address - Street 2:STE 905
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5026
Practice Address - Country:US
Practice Address - Phone:787-767-3585
Practice Address - Fax:787-274-0783
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC78041Medicare UPIN
PR93502Medicare ID - Type UnspecifiedPROVIDER NUMBER