Provider Demographics
NPI:1205510237
Name:RODRIGUEZ OTERO, NESTOR (CSFA)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:RODRIGUEZ OTERO
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:NESTOR
Other - Middle Name:
Other - Last Name:RODRIGUEZ OTERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6901 IAN CT APT 22
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2701
Mailing Address - Country:US
Mailing Address - Phone:813-606-7017
Mailing Address - Fax:
Practice Address - Street 1:6901 IAN CT APT 22
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2701
Practice Address - Country:US
Practice Address - Phone:813-606-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23-149246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant