Edmond L Otis

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

31194 Issued in CA

Practice address

26449 Bodega CT
Moreno Valley, CA 92555-2461

Phone

(760) 612-7029

NPI assigned

Jan 9, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, CA, DC3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846

  Marriage & Family Therapist

  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  DC, Marriage & Family Therapist

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1619681251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1242 UNIVERSITY AVE STE 6-570",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925078810",
            "telephone_number": "760-612-7029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26449 BODEGA CT",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925552461",
            "telephone_number": "760-612-7029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTIS",
        "first_name": "EDMOND",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-09",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "31194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Tang Ortega, PHARM.D.
• Grace Ortiz, RPH
• Kyle Oscarson, PA-C
• Ashley Oslund
• Brigid Osonwa
• Our Legacy LLC
• Abby Lynn Oursler, LMFT
• Sarah Overholtzer
• Courtney Oyler, PA
• P. Pablo Gonzalez, DDS, a Prof Corp

• Marriage & Family Therapist in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.