Provider Demographics
NPI:1275254286
Name:OTADOY, LALAINE GARCIA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LALAINE
Middle Name:GARCIA
Last Name:OTADOY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:MARY THERESE
Other - Middle Name:O
Other - Last Name:PUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5473
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90622-5473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5888 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1705
Practice Address - Country:US
Practice Address - Phone:714-716-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021158363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health