Healthcare Provider Details

I. General information

NPI: 1104962943
Provider Name (Legal Business Name): GILBERT DURITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 EL CAMINO REAL
BERKELEY CA
94705-2424
US

IV. Provider business mailing address

36 EL CAMINO REAL
BERKELEY CA
94705-2424
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-4581
  • Fax:
Mailing address:
  • Phone: 510-848-4581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberC34712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: