Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A136211 | CA |
NPI | 1073957932 |
---|---|
Provider Name | Justice Otchere |
First Address | Fresno, CA 93710-5276 |
Second Address | Fresno, CA 93710-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 12/05/2021 |