Provider Demographics
NPI:1063739662
Name:OTERO, LIZA NIVIA (BS PHARM)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:NIVIA
Last Name:OTERO
Suffix:
Gender:F
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 11 #67
Mailing Address - Street 2:URB SAN VICENTE
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-278-5800
Mailing Address - Fax:
Practice Address - Street 1:MAHI MAHI SHOPPING VILLAGE SUITE 1
Practice Address - Street 2:WALGREENS
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00643
Practice Address - Country:US
Practice Address - Phone:787-278-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist