Healthcare Provider Details

I. General information

NPI: 1750576039
Provider Name (Legal Business Name): DAVID L KUTLINA CRNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10117 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4555
US

IV. Provider business mailing address

10117 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4555
US

V. Phone/Fax

Practice location:
  • Phone: 480-767-5544
  • Fax: 480-245-7083
Mailing address:
  • Phone: 480-767-5544
  • Fax: 480-245-7083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number728827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: