Organization
RAFAEL F OTERO, PHD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL F OTERO PHD (PRES./PSYCHOLOGIST)
(903) 838-3711
Entity
Organization
Contact information
Practice address
5425 PLAZA DR, TEXARKANA, TX 75503-1662
(903) 838-3711
(903) 838-8879
Mailing address
5425 PLAZA DR, TEXARKANA, TX 75503-1662
(903) 838-3711
(903) 838-8879
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2-3031
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80433
AR BC/BS
TX
Enumeration date
06/17/2006
Last updated
01/28/2008
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