Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4161 | PR |
N | 103TA0700X | Adult Development & Aging Psychologist | 4161 | PR |
N | 103G00000X | Clinical Psychologist | 4161 | PR |
N | 103TC0700X | Clinical Psychologist | 4161 | PR |
Y | 103G00000X | Clinical Psychologist | 9959 | FL |
Y | 103TC0700X | Clinical Psychologist | 9959 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4161 | PR |
N | 208D00000X | General Practice Physician | 13642 | PR |
NPI | 1346440708 |
---|---|
Provider Name | Maria Rosa Otero Suria |
First Address | Dorado, FL 33884 |
Second Address | Winter Haven, FL 33884-1006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 17/03/2018 |