Stallworth, Otto Evans
Stallworth, Otto Evans is an individual health care provider with primary practice located at 4500 W 116Th St , Hawthorne CA 90250-2209. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Stallworth, Otto Evans can be contacted via phone (800) 883-7243.Contact Information
Primary practice address
4500 W 116Th St
Hawthorne CA 90250-2209
Phone: (800) 883-7243
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | C33769 | California |
Profile Details
| NPI number | 1639133747 |
|---|---|
| LBN Legal business name | Stallworth, Otto Evans |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 14th, 2006 |
| Last updated | Dec 29th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639133747 | NPPES |
| California | MEDICAID | 00C337690 |
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