Provider Demographics
NPI:1558767707
Name:OTERO-VO, KARLA JOYCE LAGO (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:MRS
First Name:KARLA JOYCE
Middle Name:LAGO
Last Name:OTERO-VO
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:MS
Other - First Name:KARLA JOYCE
Other - Middle Name:LAGO
Other - Last Name:OTERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FAMILY NURSE PRACTIT
Mailing Address - Street 1:14445 OLIVE VIEW DR.
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-364-4627
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DR.
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-364-4627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001525363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner