Healthcare Provider Details

I. General information

NPI: 1932317476
Provider Name (Legal Business Name): MARK KUTCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CAPITOLA RD
SANTA CRUZ CA
95062-2912
US

IV. Provider business mailing address

PO BOX 542
SANTA CRUZ CA
95061-0542
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3500
  • Fax:
Mailing address:
  • Phone: 831-427-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number88660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: