Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 243288 | NY |
Y | 208800000X | Urologist | A117082 | CA |
N | 208800000X | Urologist | AO171708 | TX |
NPI | 1053579334 |
---|---|
Provider Name | Dr. Antonio Otero |
First Address | San Francisco, CA 94115-3904 |
Second Address | San Francisco, CA 94118-3010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2008 |
Last Update Date | 15/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TPI: 213257301 | (05) | TX |