Healthcare Provider Details

I. General information

NPI: 1457336661
Provider Name (Legal Business Name): RICHARD L KRAVITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST PSSB SUTE 2400
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST PSSB SUTE 2400
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7004
  • Fax: 916-734-2732
Mailing address:
  • Phone: 916-734-7004
  • Fax: 916-734-2732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG52777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: