Provider Demographics
NPI:1457402844
Name:OTT, PATRICIA ANN (R EEG T)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:OTT
Suffix:
Gender:F
Credentials:R EEG T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 HIGHTIDE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6131
Mailing Address - Country:US
Mailing Address - Phone:310-541-7448
Mailing Address - Fax:310-541-7448
Practice Address - Street 1:1360 W 6TH ST
Practice Address - Street 2:SUITE # 350
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3514
Practice Address - Country:US
Practice Address - Phone:310-832-6428
Practice Address - Fax:310-832-5178
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1248246ZE0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATD042Medicare ID - Type Unspecified