Organization
OTEL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNESTO R OTERO-LOPEZ MD (SOLE MBR)
(800) 310-7334
Entity
Organization
Contact information
Practice address
9621 CORONADO AVE NE, ALBUQUERQUE, NM 87122-3363
(800) 310-7334
Mailing address
DEPT.880271 PO BOX 29650, PHOENIX, AZ 85038-9650
(800) 310-7334
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
514247978
MEDICAL LIC
NM
Enumeration date
09/28/2018
Last updated
04/08/2019
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