Provider Demographics
NPI:1760602809
Name:FRITZ, GEORGE (EDD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:FRITZ
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 KILOHANA ST
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-9704
Mailing Address - Country:US
Mailing Address - Phone:808-431-4715
Mailing Address - Fax:
Practice Address - Street 1:3914 KILOHANA ST
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-9704
Practice Address - Country:US
Practice Address - Phone:808-431-4715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3712L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01541631Medicaid
HIPSY-826OtherLICENSE NUMBER
PA01541631Medicaid
HIEZ720AMedicare PIN