Provider Demographics
NPI:1174849012
Name:KAITZ, JOHN BARTON (CSCS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BARTON
Last Name:KAITZ
Suffix:
Gender:M
Credentials:CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 ENCANTO WAY
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3344
Mailing Address - Country:US
Mailing Address - Phone:650-576-3953
Mailing Address - Fax:
Practice Address - Street 1:1119 ENCANTO WAY
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3344
Practice Address - Country:US
Practice Address - Phone:650-576-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist