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General NPI Number Information
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NPI Number | 1265656540
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Entity Type | Individual
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Provider Name | CAROLYN MARIE KINTZ OTR
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2040 PACIFIC COAST HWY SUITE S
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City | LOMITA
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State | CA
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Zip | 90717-2660
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Country | US
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Telephone | 310-257-6407
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Fax |
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Provider Business Mailing Address
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Address Line | 108 VIA ESTRELLITA
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City | REDONDO BEACH
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State | CA
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Zip | 90277-6449
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Country | US
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Telephone | 310-375-1454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 2247
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License Number State | CA
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