Healthcare Provider Details

I. General information

NPI: 1366893026
Provider Name (Legal Business Name): ADAM OTTAVI LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ADELINE ST STE 120
BERKELEY CA
94703-2579
US

IV. Provider business mailing address

1337 PAGE ST APT 6
SAN FRANCISCO CA
94117-3053
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1112
  • Fax:
Mailing address:
  • Phone: 907-322-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101391
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: