Healthcare Provider Details

I. General information

NPI: 1831003185
Provider Name (Legal Business Name): KRISTIN WALZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S PECK AVE
MANHATTAN BEACH CA
90266-6946
US

IV. Provider business mailing address

325 S PECK AVE
MANHATTAN BEACH CA
90266-6946
US

V. Phone/Fax

Practice location:
  • Phone: 310-318-7345
  • Fax:
Mailing address:
  • Phone: 310-318-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number710614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: