Healthcare Provider Details

I. General information

NPI: 1497101281
Provider Name (Legal Business Name): KEVIN RIUTZEL MS, DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 02/26/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 W 6TH ST STE 200
LOS ANGELES CA
90020-5108
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 213-235-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A16500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: