Provider Demographics
NPI:1205180007
Name:ZUTZ, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ZUTZ
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 1:8582 WARER AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-842-2414
Mailing Address - Fax:714-842-2912
Practice Address - Street 1:8582 WARNER AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3131
Practice Address - Country:US
Practice Address - Phone:714-842-2414
Practice Address - Fax:714-842-2912
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies