Individual
DR. DIANA M OTTULICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
822 CLARK ST, PEARL HARBOR, HI 96860-4652
(757) 836-5929
Mailing address
822 CLARK ST, PEARL HARBOR, HI 96860-4652
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
0101280042
VA
208D00000X
General Practice Physician
0101280042
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/12/2022
Last updated
05/28/2024
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