Healthcare Provider Details

I. General information

NPI: 1306240999
Provider Name (Legal Business Name): CHRISTY COTNER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 TROVITA DR
CORONA CA
92881-8713
US

IV. Provider business mailing address

7117 BROCKTON AVE
RIVERSIDE CA
92506-2658
US

V. Phone/Fax

Practice location:
  • Phone: 951-818-5097
  • Fax:
Mailing address:
  • Phone: 951-683-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95001004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: