Healthcare Provider Details

I. General information

NPI: 1649128968
Provider Name (Legal Business Name): COURTNEY ALLARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MAYVILLE PL
LADERA RANCH CA
92694-0242
US

IV. Provider business mailing address

6 MAYVILLE PL
LADERA RANCH CA
92694-0242
US

V. Phone/Fax

Practice location:
  • Phone: 951-233-1280
  • Fax:
Mailing address:
  • Phone: 951-233-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95039043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: