Provider Demographics
NPI:1083670475
Name:OTTOBONI, ADRIA ELENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIA
Middle Name:ELENE
Last Name:OTTOBONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADRIA
Other - Middle Name:OTTOBONI
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 MOUNT VERNON AVE
Mailing Address - Street 2:ROOM 1241
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4018
Mailing Address - Country:US
Mailing Address - Phone:661-326-2220
Mailing Address - Fax:661-326-2138
Practice Address - Street 1:1700 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4018
Practice Address - Country:US
Practice Address - Phone:661-326-2000
Practice Address - Fax:661-326-2165
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA82458207PE0004X
CAA82458207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00A824580Medicaid
WA00A824580Medicaid
I06507Medicare UPIN