1275979973 NPI number — KARTZINEL WELLNESS CENTER INC.

Table of content: (NPI 1275979973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275979973 NPI number — KARTZINEL WELLNESS CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARTZINEL WELLNESS CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275979973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 REDGATE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20905-5726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-989-0548
Provider Business Mailing Address Fax Number:
301-989-1543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16263 LAGUNA CANYON RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-398-7654
Provider Business Practice Location Address Fax Number:
949-407-6788
Provider Enumeration Date:
05/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KARTZINEL
Authorized Official First Name:
JERROLD
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
949-398-7654

Provider Taxonomy Codes

  • Taxonomy code: 2080P0008X , with the licence number:  G84196 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G84196 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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