Provider Demographics
NPI:1518702349
Name:OTANI BARRERA, ANDREA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:OTANI BARRERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:575 BEECH AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1659
Mailing Address - Country:US
Mailing Address - Phone:760-805-5527
Mailing Address - Fax:
Practice Address - Street 1:351 SANTA FE DR STE 110
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5137
Practice Address - Country:US
Practice Address - Phone:760-334-0128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1102101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice