Provider Demographics
NPI:1689650723
Name:OTTO, ADRIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:
Last Name:OTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S ORLANDO AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5543
Mailing Address - Country:US
Mailing Address - Phone:407-644-4053
Mailing Address - Fax:407-644-4930
Practice Address - Street 1:1400 S ORLANDO AVE
Practice Address - Street 2:STE 205
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5543
Practice Address - Country:US
Practice Address - Phone:407-644-4053
Practice Address - Fax:407-644-4930
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76007208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256622200Medicaid
FL256622200Medicaid