Provider Demographics
NPI:1356029318
Name:OTERO CABRERA, RAFAEL EDUARDO (LP)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:EDUARDO
Last Name:OTERO CABRERA
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:T3 CALLE LA TORRECILLA
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8039
Mailing Address - Country:US
Mailing Address - Phone:787-948-2651
Mailing Address - Fax:
Practice Address - Street 1:T3 CALLE LA TORRECILLA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-8039
Practice Address - Country:US
Practice Address - Phone:787-948-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR7659103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program