Provider Demographics
NPI:1780017137
Name:OTERO, BETHZAIDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BETHZAIDA
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RIO GRANDE ESTATES CALLE 9A
Mailing Address - Street 2:S12
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:UM
Mailing Address - Phone:787-463-8214
Mailing Address - Fax:
Practice Address - Street 1:URB COUNTRY CLUB CALLE 240
Practice Address - Street 2:HV 26
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:UM
Practice Address - Phone:787-463-8214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical