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General NPI Number Information
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NPI Number | 1275979973
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Entity Type | Organization
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Legal Business Name | KARTZINEL WELLNESS CENTER INC.
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 16263 LAGUNA CANYON RD SUITE 150
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City | IRVINE
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State | CA
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Zip | 92618-3609
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Country | US
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Telephone | 949-398-7654
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Fax | 949-407-6788
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Provider Business Mailing Address
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Address Line | 14 REDGATE CT
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City | SILVER SPRING
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State | MD
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Zip | 20905-5726
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Country | US
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Telephone | 301-989-0548
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Fax | 301-989-1543
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JERROLD JAY KARTZINEL
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Credential | MD
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Telephone | 949-398-7654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number | G84196
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License Number State | CA
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