Provider Demographics
NPI:1437768686
Name:KAPP, TRACI
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:KAPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:LAZAROWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1621 VENICE BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5966
Mailing Address - Country:US
Mailing Address - Phone:732-618-5623
Mailing Address - Fax:
Practice Address - Street 1:1621 VENICE BLVD APT 205
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-5966
Practice Address - Country:US
Practice Address - Phone:732-618-5623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program