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General NPI Number Information
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NPI Number | 1285207852
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Entity Type | Organization
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Legal Business Name | OTOOLE SURGICAL GROUP
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 542 S FAIR OAKS AVE FL 1
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City | PASADENA
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State | CA
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Zip | 91105-2606
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Provider Business Mailing Address
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Address Line | PO BOX 3129
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City | TORRANCE
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State | CA
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Zip | 90510-3129
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | SECRETARY
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Name | MARTIN ANDREW O'TOOLE
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Credential | MD
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Telephone | 310-792-3914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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