Individual
MR. BENNIE JUNIOR OTERO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1820 SKYLARK DR, ARLINGTON, TX 76010-3043
(817) 617-1221
Mailing address
1820 SKYLARK DR, ARLINGTON, TX 76010-3043
(817) 617-1221
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
82-3824286
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-3824286
82
TX
Enumeration date
12/28/2017
Last updated
12/28/2017
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