Healthcare Provider Details

I. General information

NPI: 1316461866
Provider Name (Legal Business Name): ALAN KRATZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1889 N RICE AVE STE 200
OXNARD CA
93030-7989
US

IV. Provider business mailing address

PO BOX 4204
VENTURA CA
93007-4204
US

V. Phone/Fax

Practice location:
  • Phone: 805-402-7940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMEDS4438
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: