Healthcare Provider Details

I. General information

NPI: 1639611700
Provider Name (Legal Business Name): SAMANTHA ROTTNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 GROVE ST STE J
BISHOP CA
93514-2652
US

IV. Provider business mailing address

162 GROVE ST STE J
BISHOP CA
93514-2652
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-6533
  • Fax: 760-872-2643
Mailing address:
  • Phone: 760-873-6533
  • Fax: 760-872-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: