Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95010981 | CA |
NPI | 1053950287 |
---|---|
Provider Name | Caitlin Rota |
First Address | Los Angeles, CA 90045-1220 |
Second Address | Redondo Beach, CA 90277-3735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2020 |
Last Update Date | 26/02/2021 |