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Organization
OTTO STALLWORTH, M.D.,INC.
Active
Organization
OTTO STALLWORTH, M.D.,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OTTO STALLWORTH M.D. (PRESIDENT)
(800) 883-7243
Entity
Organization
Contact information
Practice address
4500 W 116TH ST, HAWTHORNE, CA 90250-2209
(800) 883-7243
Mailing address
210 N TUSTIN AVE, SANTA ANA, CA 92705-3807
(714) 347-1012
(714) 647-1245
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
C33769
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C337690
—
CA
Enumeration date
11/09/2006
Last updated
12/29/2007
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