Provider Demographics
NPI:1134931090
Name:OTTERSTETTER, ALEXANDRA RADOMILE
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:RADOMILE
Last Name:OTTERSTETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-9611
Mailing Address - Country:US
Mailing Address - Phone:707-974-0569
Mailing Address - Fax:
Practice Address - Street 1:901 W RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-9611
Practice Address - Country:US
Practice Address - Phone:707-974-0569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver