Provider Demographics
NPI:1053950287
Name:ROTA, CAITLIN
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:ROTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7016 KENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1220
Mailing Address - Country:US
Mailing Address - Phone:310-710-1341
Mailing Address - Fax:
Practice Address - Street 1:432 S PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3735
Practice Address - Country:US
Practice Address - Phone:310-710-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2021-02-26
Deactivation Date:2020-07-15
Deactivation Code:
Reactivation Date:2021-02-26
Provider Licenses
StateLicense IDTaxonomies
CA95010981363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health