Healthcare Provider Details

I. General information

NPI: 1275254286
Provider Name (Legal Business Name): LALAINE GARCIA OTADOY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY THERESE O PUENTES

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PLAZA DR STE 170
FOLSOM CA
95630-4790
US

IV. Provider business mailing address

320 PINE AVE STE 1030
LONG BEACH CA
90802-2366
US

V. Phone/Fax

Practice location:
  • Phone: 916-351-9400
  • Fax:
Mailing address:
  • Phone: 310-360-7200
  • Fax: 562-317-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: