Provider Demographics
NPI:1063545341
Name:OTEYZA, CARLOS ACOSTA (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ACOSTA
Last Name:OTEYZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6144 GAZEBO PARK PL S STE 211
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1086
Mailing Address - Country:US
Mailing Address - Phone:904-551-3122
Mailing Address - Fax:904-551-3481
Practice Address - Street 1:6144 GAZEBO PARK PL S STE 211
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1086
Practice Address - Country:US
Practice Address - Phone:904-551-3122
Practice Address - Fax:904-551-3481
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43663208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61284Medicare UPIN
FLD61284Medicare UPIN