Healthcare Provider Details

I. General information

NPI: 1497178560
Provider Name (Legal Business Name): SARAH OTANO OTR/
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11838 BERNARDO PLAZA CT STE 110
SAN DIEGO CA
92128-2414
US

IV. Provider business mailing address

12325 CREEKVIEW DR UNIT 31
SAN DIEGO CA
92128-6621
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-5437
  • Fax:
Mailing address:
  • Phone: 860-655-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13681
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number00375
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: