Provider Demographics
NPI:1144459918
Name:ROBERT K. OTANI, M.D.
Entity type:Organization
Organization Name:ROBERT K. OTANI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:OTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-519-0016
Mailing Address - Street 1:P.O. BOX 8127
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-8127
Mailing Address - Country:US
Mailing Address - Phone:530-353-8438
Mailing Address - Fax:530-343-2609
Practice Address - Street 1:552 VALLOMBROSA AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-4038
Practice Address - Country:US
Practice Address - Phone:530-343-8438
Practice Address - Fax:530-343-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55038174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942313226OtherNPI TYPE I