Healthcare Provider Details

I. General information

NPI: 1750757845
Provider Name (Legal Business Name): MEGAN MICHELE KOTLARZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 S PATTERSON AVE
GOLETA CA
93111-2403
US

IV. Provider business mailing address

351 S PATTERSON AVE
GOLETA CA
93111-2403
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-6473
  • Fax:
Mailing address:
  • Phone: 805-681-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: