Provider Demographics
NPI:1023294329
Name:OTERO, ANGELICA
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:
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 1:1808 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3227
Mailing Address - Country:US
Mailing Address - Phone:213-483-6335
Mailing Address - Fax:213-483-9876
Practice Address - Street 1:1808 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-3227
Practice Address - Country:US
Practice Address - Phone:213-483-6335
Practice Address - Fax:213-483-9876
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker