Provider Demographics
NPI:1568797611
Name:KRANZ, EUGENE EDWIN (PHD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:EDWIN
Last Name:KRANZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13125
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-3125
Mailing Address - Country:US
Mailing Address - Phone:805-748-3055
Mailing Address - Fax:
Practice Address - Street 1:1075 COURT ST
Practice Address - Street 2:208
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3234
Practice Address - Country:US
Practice Address - Phone:805-748-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23155103TC0700X
ORLIMITED PERMIT 160103TC0700X
OR2066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR154739Medicare PIN
OR500628372Medicaid