Healthcare Provider Details

I. General information

NPI: 1710374954
Provider Name (Legal Business Name): EMILY OTTINIANO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 E PACIFIC COAST HWY STE 600
LONG BEACH CA
90804-6914
US

IV. Provider business mailing address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

V. Phone/Fax

Practice location:
  • Phone: 562-346-1100
  • Fax:
Mailing address:
  • Phone: 424-338-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: