Provider Demographics
NPI:1194553271
Name:OTTO, JARED (MA)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:OTTO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 DWIGHT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6471
Mailing Address - Country:US
Mailing Address - Phone:916-585-3852
Mailing Address - Fax:
Practice Address - Street 1:3137 DWIGHT RD STE 200
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-6471
Practice Address - Country:US
Practice Address - Phone:916-585-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator