MEDICARE: OTTO OSTOLAZA-GARCIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	17275	PR
2	207R00000X	Internal Medicine Physician	ME117767	FL
3	207RN0300X	Nephrology Physician	ME117767	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01402860	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ME117767	OTHER	FL	LICENSE NO

General Provider Information

NPI Number	:	1821269051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OTTO OSTOLAZA-GARCIA M.D.

Provider Business Mailing Address
First Line	:	4710 N HABANA AVE
Second Line	:	SUITE 300
City	:	TAMPA
State	:	FL
Zip	:	33614-7151
Country	:	US
Telephone Number	:	813-873-1016
Fax Number	:	813-874-2813

Provider Business Practice Location Address
First Line	:	4710 N HABANA AVE
Second Line	:	SUITE 300
City	:	TAMPA
State	:	FL
Zip	:	33614-7151
Country	:	US
Telephone Number	:	813-873-1016
Fax Number	:	813-874-2813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2008
Last Update Date	:	03/15/2024

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Directions to “ OTTO OSTOLAZA-GARCIA M.D.” Practice Location

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