Provider Demographics
NPI:1043631617
Name:OTA, LAWRENCE E (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:E
Last Name:OTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 KEYSTONE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3363
Mailing Address - Country:US
Mailing Address - Phone:323-633-4391
Mailing Address - Fax:
Practice Address - Street 1:3850 KEYSTONE AVE APT 1
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3363
Practice Address - Country:US
Practice Address - Phone:323-633-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119302207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology