Healthcare Provider Details

I. General information

NPI: 1518427616
Provider Name (Legal Business Name): HEIDI DIANE KUTZ BA, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 03/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12630 BROOKHURST ST STE D
GARDEN GROVE CA
92840-4800
US

IV. Provider business mailing address

12630 BROOKHURST ST STE D
GARDEN GROVE CA
92840-4800
US

V. Phone/Fax

Practice location:
  • Phone: 909-952-2860
  • Fax:
Mailing address:
  • Phone: 909-952-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: