Healthcare Provider Details

I. General information

NPI: 1275770661
Provider Name (Legal Business Name): RENEE SUE POZZA PHD, RN, FNP-BC, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 CAMINO DE LOS MARES SUITE 210
SAN CLEMENTE CA
92673-2835
US

IV. Provider business mailing address

675 CAMINO DE LOS MARES SUITE 210
SAN CLEMENTE CA
92673-2835
US

V. Phone/Fax

Practice location:
  • Phone: 949-496-6002
  • Fax: 949-496-6004
Mailing address:
  • Phone: 949-496-6002
  • Fax: 949-496-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number445034
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12319
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number90
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: