MEDICARE: MS. ANGELICA OTERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1023294329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELICA OTERO

Provider Business Mailing Address
First Line	:	1808 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3227
Country	:	US
Telephone Number	:	213-483-6335
Fax Number	:	213-483-9876

Provider Business Practice Location Address
First Line	:	1808 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3227
Country	:	US
Telephone Number	:	213-483-6335
Fax Number	:	213-483-9876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	01/16/2008

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