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General NPI Number Information
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NPI Number | 1467089003
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Entity Type | Individual
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Provider Name | JENICA R OTTERO
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 244 CALIFORNIA ST STE 300
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-4311
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Country | US
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Telephone | 510-999-6241
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Fax |
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Provider Business Mailing Address
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Address Line | 2330 WEBSTER ST APT 744
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City | OAKLAND
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State | CA
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Zip | 94612-3108
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Country | US
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Telephone | 303-514-2558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY31661
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License Number State | CA
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