MR. CHARLES DANIEL OTERO (NPI# 1255375903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255375903 |
| Entity Type | Individual |
| Full Name | MR. CHARLES DANIEL OTERO |
| Credential | PA |
| Practice Address |
701 Arizona St Suite A Clovis NM 88101-2110 |
| Practice Telephone | 5757423033 |
| Practice Fax Number | 5757421133 |
| Mailing Telephone | 5757423033 |
| Mailing Fax Number | 5757421133 |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2016-12-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 93-PA01 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 97903 | 05 |
| Street Address |
701 ARIZONA ST SUITE A |
| City | CLOVIS |
| State | NM |
| Zip Code | 88101-2110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134748692 | Patrick James Scollon | Military Health Care Provider | 104 W D. L. Ingram Ave, Cannon Afb, Nm 88101, Cannon Afb, NM 88101 | 2020-04-14 |
| 1285274878 | Keishla Cota | Physical Therapist | 100 East Manana Blvd, Unit 1, Clovis, NM 88101 | 2020-01-10 |
| 1659927283 | Ndeye Ndour | Nurse Anesthetist, Certified Registered | 2100 N M.l.k. Jr Blvd, Clovis, NM 88101 | 2019-08-09 |
| 1679132468 | Justine Nicole Nunez | Nurse Practitioner | 2301 North Doctor Martin Luther King Boulevard, Clovis, NM 88101 | 2019-06-06 |
| 1518453521 | Moore Psychological Services, Pllc | Social Worker | 1908 West 21st Street, Clovis, NM 88101 | 2018-07-03 |
| 1912494006 | Raesha Russell | Behavior Technician | 214 West 9th St, Clovis, NM 88101 | 2018-04-16 |
| 1013425800 | Vanessa Yardley | Registered Nurse | 2100 N. Martin Luther King Jr. Blvd., Clovis, NM 88101 | 2018-01-16 |
| 1699204230 | Olivia Garcia | Technician, Other | 1100 W 21st Street, Clovis, NM 88101 | 2017-06-07 |
| 1578006250 | Mary Ellen Gray | Technician, Other | 9408 B Vermont Court, Clovis, NM 88101 | 2016-11-29 |
| 1205296977 | Malaney Harmon | Behavioral Analyst | 2700 E 7th St., Clovis, NM 88101 | 2016-02-24 |
| Find all providers in zip 88101 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225678543 | Charla Marie Dunn | Physician Assistant | 701 Arizona St Ste A, Clovis, NM 88101-2110 | 2020-01-14 |
| 1689110066 | Tasha R Cockrum | Physician Assistant | 729 N Medical Center Dr W Ste 101, Clovis, CA 93611-6880 | 2017-01-10 |
| 1356778302 | Jonathan Crosby | Physician Assistant | 729 N Medical Center Drive West Suite 101, Clovis, CA 93611 | 2013-10-07 |
| 1851739106 | Jennifer Anne Dobrinen | Physician Assistant | 964 N Bush Ave, Clovis, CA 93611-7125 | 2013-06-10 |
| 1184871113 | Jessica Rodriguez Ohanesian | Physician Assistant | 2755 Herndon Ave., Clovis, CA 93611-0000 | 2008-08-21 |
| 1518004308 | Tony Reid | Physician Assistant | 255 W Bullard Ave Ste 109, Clovis, CA 93612-0861 | 2007-01-31 |
| 1407965478 | Patricia Lynn Bartel | Physician Assistant | 221 W Fir Ave Ste 101, Clovis, CA 93611 | 2006-08-30 |
| 1902865066 | Rajib Das | Physician Assistant | 1934 N Whiteash Ave, Clovis, CA 93619-9509 | 2006-03-18 |
| 1891309688 | Kyrian C Obidiegwu | Physician Assistant | 2021 Herndon Ave # 101, Clovis, CA 93611-6316 | 2020-08-31 |
| 1477178184 | Morgan Brooke Kelly | Physician Assistant | 604 N Magnolia Ave Ste 100, Clovis, CA 93611-9205 | 2020-06-09 |
| Find all providers in CLOVIS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.