Provider Demographics
NPI:1588966535
Name:MARIA E. OTTAVI MD, INC.
Entity type:Organization
Organization Name:MARIA E. OTTAVI MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:OTTAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-453-0577
Mailing Address - Street 1:2021 SANTA MONICA BLVD STE 240E
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2147
Mailing Address - Country:US
Mailing Address - Phone:310-453-0577
Mailing Address - Fax:310-453-2832
Practice Address - Street 1:2021 SANTA MONICA BLVD STE 240E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2147
Practice Address - Country:US
Practice Address - Phone:310-453-0577
Practice Address - Fax:310-453-2832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46681207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
EE918AMedicare PIN