| Doctor Name: | MR. MARK CLIFTON OTTOSON |
| NPI Number: | 1083905103 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | N.P. |
| License Number: | 429620 |
| Business Practice Address: | 1370 Railroad Ave Saint Helena, CA - 945741124 |
| Business Phone Number: | 7079634399 |
| Business Fax Number: | 7079634796 |
| Mailing Address: | 683 Cunard Dr, NAPA |
| State: | CA |
| Postal Code: | 945583628 |
| Phone Number: | 7072591410 |
| Fax Number: | 7079634796 |
| NPI Enumeration Date: | 04/23/2011 |
| NPI Last Update Date: | 04/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 429620 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |