Provider Demographics
NPI:1053862375
Name:GRATZ, STUART
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:GRATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GLEN ECHO
Mailing Address - Street 2:
Mailing Address - City:DOVE CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3500
Mailing Address - Country:US
Mailing Address - Phone:949-459-2565
Mailing Address - Fax:
Practice Address - Street 1:8 GLEN ECHO
Practice Address - Street 2:
Practice Address - City:DOVE CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-3500
Practice Address - Country:US
Practice Address - Phone:949-459-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028979L183500000X
COPHA0020334183500000X
FLPS52117183500000X
OR0014144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist