Provider Demographics
NPI:1053008912
Name:OTERO DURAN, ALEJANDRO JAVIER
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:JAVIER
Last Name:OTERO DURAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 BLONDELL AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2661
Mailing Address - Country:US
Mailing Address - Phone:888-700-6623
Mailing Address - Fax:
Practice Address - Street 1:1575 BLONDELL AVE STE 150
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2661
Practice Address - Country:US
Practice Address - Phone:888-700-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program