Healthcare Provider Details

I. General information

NPI: 1659798312
Provider Name (Legal Business Name): DAVID OTTO PLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 SOUTHERN BLVD SE STE 14
RIO RANCHO NM
87124-3750
US

IV. Provider business mailing address

3280 ESPLANADE CIR SE
RIO RANCHO NM
87124-7619
US

V. Phone/Fax

Practice location:
  • Phone: 505-994-0161
  • Fax:
Mailing address:
  • Phone: 505-464-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2025-0601
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: