Provider Demographics
NPI:1841208766
Name:OTTAVI, MARIA ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELLEN
Last Name:OTTAVI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 240E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-453-0577
Mailing Address - Fax:310-453-2832
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 240E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-453-0577
Practice Address - Fax:310-453-2832
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-02-06
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Provider Licenses
StateLicense IDTaxonomies
CAA46681207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEE918AMedicare PIN
F44346Medicare UPIN