Provider Demographics
NPI:1699373811
Name:OTERO, ADALINE YVETTE
Entity Type:Individual
Prefix:
First Name:ADALINE
Middle Name:YVETTE
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 1:715 N BROADWAY APT 312
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1882
Mailing Address - Country:US
Mailing Address - Phone:401-486-4285
Mailing Address - Fax:
Practice Address - Street 1:715 NORTH BROADWAY APT 312 BLDG B
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-9202
Practice Address - Country:US
Practice Address - Phone:401-486-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95174217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily