Provider Demographics
NPI:1700356482
Name:OTERO, JENNIFFER (RN CIC)
Entity type:Individual
Prefix:
First Name:JENNIFFER
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:RN CIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. ESTANCIAS DEL MAYORAL CALLE GUAJANA # 12032
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-381-5958
Mailing Address - Fax:
Practice Address - Street 1:URB. ESTANCIAS DEL MAYORAL CALLE GUAJANA # 12032
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-381-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR71763163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control