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General NPI Number Information
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NPI Number | 1952940306
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Entity Type | Individual
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Provider Name | CORY DANIEL OTT CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 2927 DE LA VINA ST
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City | SANTA BARBARA
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State | CA
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Zip | 93105-3362
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Country | US
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Telephone | 805-770-3378
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Fax |
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Provider Business Mailing Address
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Address Line | 345 E OHIO ST APT 601
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City | CHICAGO
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State | IL
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Zip | 60611-3972
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Country | US
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Telephone | 818-312-1347
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95001325
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License Number State | CA
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