Healthcare Provider Details

I. General information

NPI: 1487110466
Provider Name (Legal Business Name): PATRICIA ANN OTSUJI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24953 PASEO DE VALENCIA BUILDING B SUITE 1B
LAGUNA HILLS CA
92653-4342
US

IV. Provider business mailing address

24953 PASEO DE VALENCIA BUILDING B SUITE 1B
LAGUNA HILLS CA
92653
US

V. Phone/Fax

Practice location:
  • Phone: 949-540-0170
  • Fax: 949-540-0173
Mailing address:
  • Phone: 949-540-0170
  • Fax: 949-540-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA021950216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: