Healthcare Provider Details

I. General information

NPI: 1265499396
Provider Name (Legal Business Name): ROSEMARY ANN CLARKE RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY SUITE 351
MISSION VIEJO CA
92691-6306
US

IV. Provider business mailing address

263 SANDCASTLE
ALISO VIEJO CA
92656-3821
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1007
  • Fax:
Mailing address:
  • Phone: 949-215-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number475078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: