Individual
JACQUELINE OTAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1234
Mailing address
8770 WASHINGTON BLVD APT 420, CULVER CITY, CA 90232-2482
(860) 519-6073
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
114672-23
NH
367500000X
Certified Registered Nurse Anesthetist
Primary
80042
NM
Other
Enumeration date
07/31/2023
Last updated
07/02/2025
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