=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437158847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDWARD CHARLES KRAVITZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2005
-----------------------------------------------------
Last Update Date | 08/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 W LA VETA AVE STE. 203
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92866-2607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-835-4404
-----------------------------------------------------
Fax | 714-532-6563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7054
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92863-7054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-571-5000
-----------------------------------------------------
Fax | 714-571-5055
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | C26238
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------