Healthcare Provider Details

I. General information

NPI: 1174849012
Provider Name (Legal Business Name): JOHN BARTON KAITZ C.S.C.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 ENCANTO WAY
PACIFICA CA
94044-3344
US

IV. Provider business mailing address

1119 ENCANTO WAY
PACIFICA CA
94044-3344
US

V. Phone/Fax

Practice location:
  • Phone: 650-576-3953
  • Fax:
Mailing address:
  • Phone: 650-576-3953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: