Individual
DR. MARIO OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-0920
(602) 933-2492
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
52752-20
WI
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
63758
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
097026
—
AZ
Enumeration date
04/23/2007
Last updated
10/12/2021
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