Provider Demographics
NPI: | 1518207596 |
---|---|
Name: | MD HEALTH CLINICS |
Entity Type: | Organization |
Organization Name: | MD HEALTH CLINICS |
Other - Org Name: | ROBERT KUTZNER MD |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | RUSSELL |
Authorized Official - Last Name: | KUTZNER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 714-486-6866 |
Mailing Address - Street 1: | 2549 EASTBLUFF DR |
Mailing Address - Street 2: | #744 |
Mailing Address - City: | NEWPORT BEACH |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92660-3500 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-486-6866 |
Mailing Address - Fax: | 949-274-8925 |
Practice Address - Street 1: | 1000 QUAIL ST STE 160 |
Practice Address - Street 2: | |
Practice Address - City: | NEWPORT BEACH |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92660-2721 |
Practice Address - Country: | US |
Practice Address - Phone: | 877-788-6342 |
Practice Address - Fax: | 949-274-8925 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-02-27 |
Last Update Date: | 2023-03-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 14246 | 103TA0400X |
CA | PSY14246 | 103TB0200X, 103TP2701X |
CA | G52483 | 207LA0401X, 207RA0401X, 2081P2900X, 208VP0000X, 208VP0014X |
207LP2900X, 225700000X, 261QP3300X | ||
CA | G12893 | 2084A0401X, 2084P2900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QP3300X | Ambulatory Health Care Facilities | Clinic/Center | Pain | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
No | 207LA0401X | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | Group - Multi-Specialty |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207RA0401X | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
No | 2084A0401X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | Group - Multi-Specialty |
No | 2084P2900X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine | Group - Multi-Specialty |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | B57939 | Medicare UPIN |