Individual
MICHAEL OTANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
916 N MAIN ST, LAS VEGAS, NV 89101-1931
(702) 202-6647
Mailing address
916 N MAIN ST, LAS VEGAS, NV 89101-1931
(702) 202-6647
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
PRSS-5374
NV
Other
Enumeration date
07/10/2026
Last updated
07/10/2026
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