MEDICARE: KARYN HAITZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	271832	MA
2	207N00000X	Dermatology Physician	A175492	CA

General Provider Information

NPI Number	:	1962932384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARYN HAITZ

Provider Business Mailing Address
First Line	:	302 INNOVATION DR STE 400
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-5997
Country	:	US
Telephone Number	:	562-430-4294
Fax Number	:	562-493-3573

Provider Business Practice Location Address
First Line	:	3772 KATELLA AVE STE 206
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-6428
Country	:	US
Telephone Number	:	562-430-4294
Fax Number	:	562-493-3573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2017
Last Update Date	:	08/19/2022

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Directions to “ KARYN HAITZ ” Practice Location

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