Healthcare Provider Details

I. General information

NPI: 1215393384
Provider Name (Legal Business Name): DESIRAE MUTUC FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23141 VERDUGO DR STE 201
LAGUNA HILLS CA
92653-1341
US

IV. Provider business mailing address

23141 VERDUGO DR STE 201
LAGUNA HILLS CA
92653-1341
US

V. Phone/Fax

Practice location:
  • Phone: 949-215-5055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: