Provider Demographics
NPI:1871517276
Name:MARITZA OTERO MD, PA
Entity type:Organization
Organization Name:MARITZA OTERO MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-302-5998
Mailing Address - Street 1:8567 CORAL WAY # 187
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2335
Mailing Address - Country:US
Mailing Address - Phone:305-302-5998
Mailing Address - Fax:305-266-1385
Practice Address - Street 1:717 PONCE DE LEON BLVD
Practice Address - Street 2:327
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2060
Practice Address - Country:US
Practice Address - Phone:305-447-1396
Practice Address - Fax:305-267-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275488600Medicaid
FLK9576Medicare PIN
FL275488600Medicaid