Healthcare Provider Details

I. General information

NPI: 1457469371
Provider Name (Legal Business Name): ADAM MICHAEL ROTUNDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 QUAIL ST SUITE 102
NEWPORT BEACH CA
92660-2701
US

IV. Provider business mailing address

50 TOWNSEND
IRVINE CA
92620-2820
US

V. Phone/Fax

Practice location:
  • Phone: 949-336-7171
  • Fax: 949-336-7172
Mailing address:
  • Phone: 949-336-7288
  • Fax: 949-336-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA81640
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA81640
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA81640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: