Provider Demographics
NPI:1306827944
Name:KUTZ, DAVID LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEONARD
Last Name:KUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 BROADWAY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2227
Mailing Address - Country:US
Mailing Address - Phone:707-645-2700
Mailing Address - Fax:
Practice Address - Street 1:1761 BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2227
Practice Address - Country:US
Practice Address - Phone:707-645-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0803732084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry