Individual
MR. CHARLES DANIEL OTERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
701 ARIZONA ST, SUITE A, CLOVIS, NM 88101-2110
(575) 742-3033
(575) 742-1133
Mailing address
701 ARIZONA ST, SUITE A, CLOVIS, NM 88101-2110
(575) 742-3033
(575) 742-1133
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
93-PA01
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97903
—
NM
Enumeration date
06/15/2006
Last updated
12/27/2016
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