Healthcare Provider Details

I. General information

NPI: 1689454449
Provider Name (Legal Business Name): YURINA OTSUKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 H ST NE STE 1579
WASHINGTON DC
20002-3627
US

IV. Provider business mailing address

712 H ST NE STE 1579
WASHINGTON DC
20002-3627
US

V. Phone/Fax

Practice location:
  • Phone: 202-234-7738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGPC200001579
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: