Healthcare Provider Details

I. General information

NPI: 1720079957
Provider Name (Legal Business Name): ROXANNA MORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29525 CANWOOD ST STE 111
AGOURA HILLS CA
91301-4233
US

IV. Provider business mailing address

2831 LADBROOK WAY
THOUSAND OAKS CA
91361-5068
US

V. Phone/Fax

Practice location:
  • Phone: 818-706-8133
  • Fax:
Mailing address:
  • Phone: 805-495-6959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN525069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: