Healthcare Provider Details

I. General information

NPI: 1992077317
Provider Name (Legal Business Name): JENNIFER L OTTINO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15611 POMERADO RD STE 400
POWAY CA
92064-2437
US

IV. Provider business mailing address

15611 POMERADO RD STE 400
POWAY CA
92064-2437
US

V. Phone/Fax

Practice location:
  • Phone: 858-675-3100
  • Fax:
Mailing address:
  • Phone: 858-675-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0102203606
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A18596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: