Individual
MS. MAYUMI OTSUKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
516 EAST NIZHONI BLVD, GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1268
Mailing address
P.O. BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(505) 722-1268
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0420010593
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24559342
—
CO
05
—
63139324
—
NM
05
—
811457
—
AZ
Enumeration date
09/30/2005
Last updated
04/29/2016
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