Healthcare Provider Details

I. General information

NPI: 1669115366
Provider Name (Legal Business Name): CLARISSA SPITZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17236 SATICOY ST
VAN NUYS CA
91406-2103
US

IV. Provider business mailing address

916 N TURNER AVE APT 62
ONTARIO CA
91764-5304
US

V. Phone/Fax

Practice location:
  • Phone: 818-600-8912
  • Fax:
Mailing address:
  • Phone: 626-940-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95032742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: