Provider Demographics
NPI:1679776181
Name:OTERO, LILIA ESTHER (ND-CDN)
Entity type:Individual
Prefix:MRS
First Name:LILIA
Middle Name:ESTHER
Last Name:OTERO
Suffix:
Gender:F
Credentials:ND-CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 AVE. CAMPO RICO
Mailing Address - Street 2:COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-701-4938
Mailing Address - Fax:787-701-4790
Practice Address - Street 1:877 AVE. CAMPO RICO
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-701-4938
Practice Address - Fax:787-701-4790
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004637133N00000X
DCNAT451175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85189Medicare ID - Type UnspecifiedAMME