Healthcare Provider Details

I. General information

NPI: 1639081110
Provider Name (Legal Business Name): MARIAH KAITZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA ST FL 7
SAN FRANCISCO CA
94110-4423
US

IV. Provider business mailing address

1119 ENCANTO WAY
PACIFICA CA
94044-3344
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-5450
  • Fax: 415-600-5420
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: