Active NPI
Sufian Otoum, PHARM D
- Pharmacist
- San Diego, CA
National Provider Identifier
1134523616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 53174
- Practice address
- 3131 Camino del Rio N
San Diego, CA 92108-5701 - Phone
- (800) 788-4863
- NPI assigned
- Oct 13, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 53174 | CA | Primary |
Addresses
Primary practice location
3131 Camino del Rio N
San Diego, CA 92108-5701
Mailing address
6185 Magnolia Ave
# 132
Riverside, CA 92506-2524
Phone (909) 210-7206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53174 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415750400000",
"number": "1134523616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6185 MAGNOLIA AVE",
"address_2": "# 132",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925062524",
"telephone_number": "909-210-7206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3131 CAMINO DEL RIO N",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921085701",
"telephone_number": "800-788-4863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTOUM",
"first_name": "SUFIAN",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-13",
"last_updated": "2014-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "53174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.