Provider Demographics
NPI:1790289791
Name:OTERO, RAFAEL
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:OTERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 RIDGEWOOD ST STE B
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-0102
Mailing Address - Country:US
Mailing Address - Phone:956-667-5298
Mailing Address - Fax:956-667-5299
Practice Address - Street 1:832 RIDGEWOOD ST STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-0102
Practice Address - Country:US
Practice Address - Phone:956-667-5298
Practice Address - Fax:956-667-5299
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT4446207R00000X
FLME148423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine