Healthcare Provider Details

I. General information

NPI: 1700035946
Provider Name (Legal Business Name): ADAM M. ROTUNDA, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2008
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 QUAIL ST STE 102
NEWPORT BEACH CA
92660-2702
US

IV. Provider business mailing address

1100 QUAIL ST STE 102
NEWPORT BEACH CA
92660-2702
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA81640
License Number StateCA

VIII. Authorized Official

Name: ADAM MICHAEL ROTUNDA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-336-7171