Provider Demographics
NPI:1346223997
Name:OTIKO, CHRISTOPHER AYODELE (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:AYODELE
Last Name:OTIKO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 RESEDA BLVD
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-5340
Mailing Address - Country:US
Mailing Address - Phone:818-708-7668
Mailing Address - Fax:310-943-1457
Practice Address - Street 1:6650 RESEDA BLVD
Practice Address - Street 2:SUITE 101A
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-5340
Practice Address - Country:US
Practice Address - Phone:818-708-7668
Practice Address - Fax:310-943-1457
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4159213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E41591Medicaid
CAE4159OtherLICENSE NUMBER
CAE4159OtherLICENSE NUMBER