Provider Demographics
NPI:1720571714
Name:OTANO, MARIA VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VICTORIA
Last Name:OTANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:OTANO PEREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3491 34TH ST
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711
Mailing Address - Country:US
Mailing Address - Phone:273-692-7897
Mailing Address - Fax:727-369-0211
Practice Address - Street 1:3491 34TH ST
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711
Practice Address - Country:US
Practice Address - Phone:273-692-7897
Practice Address - Fax:727-369-0211
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine