Provider Demographics
NPI:1992424626
Name:OTANDO, TARYN
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:OTANDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2513 GRAY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76247-2062
Mailing Address - Country:US
Mailing Address - Phone:303-324-4254
Mailing Address - Fax:
Practice Address - Street 1:9115 LELAND DR
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:TX
Practice Address - Zip Code:76226-5556
Practice Address - Country:US
Practice Address - Phone:303-324-4254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide