Individual
MR. JUAN OTENNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
1460 N LAKE AVE, PASADENA, CA 91104-2300
(626) 294-1079
Mailing address
1460 N LAKE AVE, PASADENA, CA 91104-2300
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT29037
CA
Other
Enumeration date
03/10/2017
Last updated
01/25/2019
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