MEDICARE: ANDREW OTTO M.D.

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	207P00000X	Emergency Medicine Physician	MD61129047	WA
2	207P00000X	Emergency Medicine Physician	A138024	CA

General Provider Information

NPI Number	:	1578862157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW OTTO M.D.

Provider Business Mailing Address
First Line	:	3559 VERNAL AVE
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95340-0638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 N CALIFORNIA BLVD
Second Line	:	SUITE #400
City	:	WALNUT CREEK
State	:	CA
Zip	:	94596-3742
Country	:	US
Telephone Number	:	540-981-7000
Fax Number	:

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

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	06/15/2022

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