Provider Demographics
NPI:1902002934
Name:OTERO, MARITZA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109C AGUA AZUL
Mailing Address - Street 2:URBANIZACION COSTA NORTE
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-2733
Mailing Address - Country:US
Mailing Address - Phone:787-319-8004
Mailing Address - Fax:
Practice Address - Street 1:109C AGUA AZUL
Practice Address - Street 2:URBANIZACION COSTA NORTE
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-2733
Practice Address - Country:US
Practice Address - Phone:787-319-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical