Healthcare Provider Details

I. General information

NPI: 1275979973
Provider Name (Legal Business Name): KARTZINEL WELLNESS CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16263 LAGUNA CANYON RD SUITE 150
IRVINE CA
92618-3609
US

IV. Provider business mailing address

14 REDGATE CT
SILVER SPRING MD
20905-5726
US

V. Phone/Fax

Practice location:
  • Phone: 949-398-7654
  • Fax: 949-407-6788
Mailing address:
  • Phone: 301-989-0548
  • Fax: 301-989-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberG84196
License Number StateCA

VIII. Authorized Official

Name: DR. JERROLD JAY KARTZINEL
Title or Position: PHYSICIAN
Credential: MD
Phone: 949-398-7654