Active NPI
Rafael F Otero, PHD
- Clinical Psychologist
- Texarkana, TX
National Provider Identifier
1497784748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 85-3P
- Practice address
- 5425 Plaza Dr
Texarkana, TX 75503-1662 - Phone
- (903) 838-3711
- Fax
- (903) 838-8879
- NPI assigned
- Jun 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 85-3P | AR | Primary |
Addresses
Primary practice location
5425 Plaza Dr
Texarkana, TX 75503-1662
Mailing address
5425 Plaza Dr
Texarkana, TX 75503-1662
Phone (903) 838-3711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80433 | Other | AR | AR BC/BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 85-3P | AR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201478400000",
"number": "1497784748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5425 PLAZA DR",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755031662",
"telephone_number": "903-838-3711",
"fax_number": "903-838-8879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5425 PLAZA DR",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755031662",
"telephone_number": "903-838-3711",
"fax_number": "903-838-8879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTERO",
"first_name": "RAFAEL",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-30",
"last_updated": "2008-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AR",
"license": "85-3P",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AR BC/BS",
"identifier": "80433",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, TX
- Ayotokunbo Olosunde, MD
- Oral and Maxillofacial Surgeons of Northeast Texas, P. a.
- Oral and Maxillofacial Surgeons of Northeast Texas, PLLC
- Orpro Inc
- Orthodomicile
- Otm Health & Physical Therapy
- Otolaryngology and Head & Neck Surgery Associates, LLP
- Brianna Leigh Otwell, LPC INTERN
- Kouassi Adaman Ouattara, RPH
- Mari Varga Overlock, PH. D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.