Healthcare Provider Details

I. General information

NPI: 1922265651
Provider Name (Legal Business Name): PATRICIA ROSINE KOVALCHECK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 SUPERIOR AVE SUITE 1
NEWPORT BEACH CA
92663-2723
US

IV. Provider business mailing address

PO BOX 2343
NEWPORT BEACH CA
92659-1343
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-0587
  • Fax: 949-631-8155
Mailing address:
  • Phone: 949-642-1488
  • Fax: 949-631-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number271341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: