Healthcare Provider Details

I. General information

NPI: 1821370602
Provider Name (Legal Business Name): COURTNEY A ROTZ M.S.N., N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26800 CROWN VALLEY PKWY STE 120
MISSION VIEJO CA
92691-8033
US

IV. Provider business mailing address

10 WAVERLY PL
LADERA RANCH CA
92694-0220
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-3388
  • Fax:
Mailing address:
  • Phone: 801-822-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number763952
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95011283
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95011283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: