Individual
DR. SHIRLEY M. OTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10666 N TORREY PINES RD, LA JOLLA, CA 92037-1027
(858) 554-8892
Mailing address
FILE# 54433, LOS ANGELES, CA 90074-0001
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
G14706
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G147060
—
CA
01
—
340005983
RAILROAD MEDICARE
—
01
—
F020
CHAMPUS
—
Enumeration date
04/04/2006
Last updated
06/26/2009
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