Healthcare Provider Details

I. General information

NPI: 1114919180
Provider Name (Legal Business Name): EDWARD C. KRAVITZ, M.D., INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W LA VETA AVE STE. 201
ORANGE CA
92866-2607
US

IV. Provider business mailing address

PO BOX 7054
ORANGE CA
92863-7054
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-4404
  • Fax:
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD C. KRAVITZ
Title or Position: OWNER
Credential: M.D.
Phone: 714-835-4404