Healthcare Provider Details

I. General information

NPI: 1386117349
Provider Name (Legal Business Name): BIANCA ANNE OTAROLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 HARRISON ST STE 1800
OAKLAND CA
94612-4700
US

IV. Provider business mailing address

15398 FARNSWORTH ST
SAN LEANDRO CA
94579-2014
US

V. Phone/Fax

Practice location:
  • Phone: 916-729-3098
  • Fax:
Mailing address:
  • Phone: 510-798-2368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: