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NPI Code Detail

MEDICARE: RONALD J OTTO MD

MEDICARE:   RONALD J OTTO  MD
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
12085R0202XDiagnostic Radiology PhysicianG51511CA

Other Identifiers

General Provider Information

NPI Number : 1710988647
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD J OTTO MD
Provider Business Mailing Address
First Line : PO BOX 15648
Second Line :
City : SACRAMENTO
State : CA
Zip : 95852-0648
Country : US
Telephone Number : 951-781-2270
Fax Number : 951-781-2293
Provider Business Practice Location Address
First Line : 4445 MAGNOLIA AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92501-4135
Country : US
Telephone Number : 951-788-3400
Fax Number : 951-788-3194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 06/16/2008

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Directions to “ RONALD J OTTO MD” Practice Location

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