Provider Demographics
NPI:1861480261
Name:KURAITIS, KESTUTIS V (MD)
Entity Type:Individual
Prefix:
First Name:KESTUTIS
Middle Name:V
Last Name:KURAITIS
Suffix:
Gender:M
Credentials:MD
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 651
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-0651
Mailing Address - Country:US
Mailing Address - Phone:760-351-2626
Mailing Address - Fax:760-351-2616
Practice Address - Street 1:751 W LEGION RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7732
Practice Address - Country:US
Practice Address - Phone:760-351-2626
Practice Address - Fax:760-351-2616
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60362207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G603620Medicaid
CAWG60362CMedicare PIN
CA00G603620Medicaid