MEDICARE: DPMOTIKONRCA LLC

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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1285952150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DPMOTIKONRCA LLC

Provider Business Mailing Address
First Line	:	5550 OWENSMOUTH AVE
Second Line	:	APT.202
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7032
Country	:	US
Telephone Number	:	951-288-3998
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 PIONEER LN
Second Line	:
City	:	BISHOP
State	:	CA
Zip	:	93514-2557
Country	:	US
Telephone Number	:	951-288-3998
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER OTIKO
Credential	:	DPM
Telephone Number	:	951-288-3998

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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