Healthcare Provider Details

I. General information

NPI: 1417428731
Provider Name (Legal Business Name): VINITA R KOTHARI C-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2018
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4288 KATELLA AVE
LOS ALAMITOS CA
90720-3562
US

IV. Provider business mailing address

5287 VIA ANDALUSIA
YORBA LINDA CA
92886-5018
US

V. Phone/Fax

Practice location:
  • Phone: 562-548-2713
  • Fax:
Mailing address:
  • Phone: 714-865-7995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF1180657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: