Provider Demographics
NPI:1003117649
Name:KREIDEL, MARIT KAY (MD)
Entity type:Individual
Prefix:DR
First Name:MARIT
Middle Name:KAY
Last Name:KREIDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIT
Other - Middle Name:KREIDEL
Other - Last Name:REIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6 WILLARD
Mailing Address - Street 2:DEPT OF DERMATOLOGY
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4694
Mailing Address - Country:US
Mailing Address - Phone:949-262-5780
Mailing Address - Fax:
Practice Address - Street 1:6 WILLARD
Practice Address - Street 2:DEPT OF DERMATOLOGY
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4694
Practice Address - Country:US
Practice Address - Phone:949-262-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116418207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology