Provider Demographics
NPI:1790961381
Name:NEUTZ, EBERHARD S
Entity Type:Individual
Prefix:DR
First Name:EBERHARD
Middle Name:S
Last Name:NEUTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 EMERALD BAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1229
Mailing Address - Country:US
Mailing Address - Phone:949-497-2690
Mailing Address - Fax:949-376-6073
Practice Address - Street 1:909 EMERALD BAY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-1229
Practice Address - Country:US
Practice Address - Phone:949-497-2690
Practice Address - Fax:949-376-6073
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31893207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A318930Medicaid
CA00A318930Medicaid