Provider Demographics
NPI:1669838082
Name:OTERO, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OTERO
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 1:10020 ALONDRA BLVD APT 9
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3928
Mailing Address - Country:US
Mailing Address - Phone:323-516-9996
Mailing Address - Fax:
Practice Address - Street 1:13428 MAXELLA AVE STE 913
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5620
Practice Address - Country:US
Practice Address - Phone:424-272-5238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst