Healthcare Provider Details

I. General information

NPI: 1124152509
Provider Name (Legal Business Name): APRIL MICHELLE ROTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 S VERMONT AVE #A200
TORRANCE CA
90502-7009
US

IV. Provider business mailing address

14811 S DENKER AVE
GARDENA CA
90247-2818
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-6887
  • Fax:
Mailing address:
  • Phone: 310-213-8764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number57194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: