MEDICARE: DR. DAVID J KUTZ PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	949	LA
2	103TC0700X	Clinical Psychologist	1031	NM

General Provider Information

NPI Number	:	1245397066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J KUTZ PHD

Provider Business Mailing Address
First Line	:	2074 GALISTEO ST
Second Line	:	A1
City	:	SANTA FE
State	:	NM
Zip	:	87505-2138
Country	:	US
Telephone Number	:	505-345-6100
Fax Number	:	505-345-4531

Provider Business Practice Location Address
First Line	:	2074 GALISTEO ST
Second Line	:	A1
City	:	SANTA FE
State	:	NM
Zip	:	87505-2138
Country	:	US
Telephone Number	:	505-345-6100
Fax Number	:	505-345-4531

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	01/12/2015

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