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General NPI Number Information
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NPI Number | 1821004144
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Entity Type | Individual
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Provider Name | RICHARD ALAN OTT M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/06/2022
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Provider Practice Location Address
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Address Line | 1211 W LA PALMA AVE STE 608
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City | ANAHEIM
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State | CA
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Zip | 92801-2813
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Country | US
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Telephone | 714-774-1102
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Fax | 949-459-0100
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Provider Business Mailing Address
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Address Line | PO BOX 9036
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-1036
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Country | US
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Telephone | 714-774-1102
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Fax | 949-459-0100
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | G45864
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License Number State | CA
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