Provider Demographics
NPI:1154961977
Name:OTERO, JEREMIAH B (HAD)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:B
Last Name:OTERO
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3454 ZAFARANO DR STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2667
Mailing Address - Country:US
Mailing Address - Phone:505-988-1984
Mailing Address - Fax:505-474-3078
Practice Address - Street 1:3454 ZAFARANO DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2667
Practice Address - Country:US
Practice Address - Phone:505-988-1984
Practice Address - Fax:505-474-3078
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMHAD0888237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist