Provider Demographics
NPI:1295912335
Name:OTERO-QUINTERO, SARAH (DPM, MS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:OTERO-QUINTERO
Suffix:
Gender:F
Credentials:DPM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2440
Mailing Address - Country:US
Mailing Address - Phone:520-417-2244
Mailing Address - Fax:
Practice Address - Street 1:4810 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2440
Practice Address - Country:US
Practice Address - Phone:520-417-2244
Practice Address - Fax:520-459-0487
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002220213ES0103X
AZ675213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00824006OtherRAILROAD MEDICARE