Healthcare Provider Details

I. General information

NPI: 1942866967
Provider Name (Legal Business Name): DIANA OTOYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIVISION OF VASCULAR SURGERY 30 N MARIO CAPECCHI DR.
SALT LAKE CITY UT
84112
US

IV. Provider business mailing address

DIVISION OF VASCULAR SURGERY 30 N MARIO CAPECCHI DR.
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-646-9120
  • Fax:
Mailing address:
  • Phone: 801-646-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number14281244-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101272904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: