Provider Demographics
NPI:1982867768
Name:KREITZ, LARAE
Entity Type:Individual
Prefix:
First Name:LARAE
Middle Name:
Last Name:KREITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N RAMONA BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-2567
Mailing Address - Country:US
Mailing Address - Phone:951-663-4842
Mailing Address - Fax:
Practice Address - Street 1:950 N RAMONA BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-2567
Practice Address - Country:US
Practice Address - Phone:951-663-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health