Individual
NICOLE OTERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1900 N HIGLEY RD, GILBERT, AZ 85234-1604
(480) 543-2000
Mailing address
2520 S PLAZA DR APT 1003, TEMPE, AZ 85282-1028
(847) 630-8630
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/07/2015
Last updated
09/14/2021
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