Healthcare Provider Details

I. General information

NPI: 1407432594
Provider Name (Legal Business Name): DIANA ADANNA OTUWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12291 WASHINGTON BLVD STE 500
WHITTIER CA
90606-2551
US

IV. Provider business mailing address

12291 WASHINGTON BLVD STE 500
WHITTIER CA
90606-2551
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0811
  • Fax:
Mailing address:
  • Phone: 562-698-2541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA187499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: