Provider Demographics
NPI:1376330191
Name:ALFONSO OTERO, RICHELIZ (MD)
Entity type:Individual
Prefix:
First Name:RICHELIZ
Middle Name:
Last Name:ALFONSO OTERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CALLE HORTENSIA APT 1I
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6402
Mailing Address - Country:US
Mailing Address - Phone:787-934-7986
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE HORTENSIA APT 1I
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6402
Practice Address - Country:US
Practice Address - Phone:787-934-7986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program