Healthcare Provider Details

I. General information

NPI: 1861480261
Provider Name (Legal Business Name): KESTUTIS V KURAITIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 W LEGION RD SUITE 204
BRAWLEY CA
92227-7732
US

IV. Provider business mailing address

PO BOX 651
BRAWLEY CA
92227-0651
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-2626
  • Fax: 760-351-2616
Mailing address:
  • Phone: 760-351-2626
  • Fax: 760-351-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG60362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: