Diana M Ottulich, MD

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

License

0101280042 Issued in VA

Practice address

822 Clark St
Pearl Harbor, HI 96860-4652

Phone

(757) 836-5929

NPI assigned

May 12, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1652313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1629715552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 CLARK ST",
            "city": "PEARL HARBOR",
            "state": "HI",
            "postal_code": "968604652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 CLARK ST",
            "city": "PEARL HARBOR",
            "state": "HI",
            "postal_code": "968604652",
            "telephone_number": "757-836-5929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTULICH",
        "first_name": "DIANA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-12",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101280042",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "VA",
            "license": "0101280042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Oblein
• Nathaniel C. Olipas
• Karolyn Sue Omo, L.P.N.
• Barbara M. Ornellas, R.N.
• Linda Sharon Otani, P.A.-C
• Kylie Breann Pace, DDS
• Analisa G Page, RN
• Grant Hudson Palmer, DMD
• Lynette Parker, RN
• Melinda Ranee Parker, RN

• Military Health Care Provider in Pearl Harbor, HI
• Providers in Pearl Harbor, HI by specialty
• Military Health Care Provider in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; 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.