Healthcare Provider Details

I. General information

NPI: 1689545212
Provider Name (Legal Business Name): PEACILLIA ANWILI OTUYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 10/24/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 MOTOR AVE STE 110
LOS ANGELES CA
90034-3766
US

IV. Provider business mailing address

119 W TORRANCE BLVD 110
REDONDO BEACH CA
90277
US

V. Phone/Fax

Practice location:
  • Phone: 424-672-6700
  • Fax: 323-455-6267
Mailing address:
  • Phone: 310-374-3300
  • Fax: 310-374-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: