Provider Demographics
NPI:1023398914
Name:OTERO, JORGE L (LMT)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:OTERO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 S DIXIE HWY APT 404
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3544
Mailing Address - Country:US
Mailing Address - Phone:786-227-9010
Mailing Address - Fax:
Practice Address - Street 1:3050 S DIXIE HWY APT 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-3544
Practice Address - Country:US
Practice Address - Phone:786-227-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy