Individual
ROBERT KEN OTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-8660
Mailing address
3221 WAGNER HEIGHTS RD, STOCKTON, CA 95209-4868
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
33792
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
04/10/2007
Last updated
01/10/2024
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