Provider Demographics
NPI:1114090461
Name:BRETZIUS-HURWITZ, KATHLEEN ANN (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:BRETZIUS-HURWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:HURWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25395 HANCOCK AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9009
Mailing Address - Country:US
Mailing Address - Phone:951-698-0300
Mailing Address - Fax:951-698-3719
Practice Address - Street 1:25395 HANCOCK AVE STE 250
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9009
Practice Address - Country:US
Practice Address - Phone:951-698-0300
Practice Address - Fax:951-698-3719
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61204103TB0200X, 2080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61204OtherSTATE LICENSE