Provider Demographics
NPI:1821411463
Name:MICHAEL OTERO ANESTHESIA SERVICES
Entity Type:Organization
Organization Name:MICHAEL OTERO ANESTHESIA SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-474-8328
Mailing Address - Street 1:31 CALLE COBANA
Mailing Address - Street 2:URB. LADERAS DE SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9314
Mailing Address - Country:US
Mailing Address - Phone:787-474-8328
Mailing Address - Fax:787-474-8328
Practice Address - Street 1:11310 AVE. 65 DE INFANTERIA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-769-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10007207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89194Medicare UPIN