Provider Demographics
NPI:1982187860
Name:OTERO, STELLA MARIA
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:MARIA
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:AV6 CALLE 43
Mailing Address - Street 2:REPARTO TERESITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-529-5701
Mailing Address - Fax:
Practice Address - Street 1:AV6 CALLE 43
Practice Address - Street 2:REPARTO TERESITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-0096
Practice Address - Country:US
Practice Address - Phone:787-529-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR143731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14373OtherPERMANENT LICENCE