Provider Demographics
NPI:1740635374
Name:KIRTZ, KESHIA
Entity type:Individual
Prefix:
First Name:KESHIA
Middle Name:
Last Name:KIRTZ
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 1:28160 MCBEAN PKWY
Mailing Address - Street 2:APT 7302
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1119
Mailing Address - Country:US
Mailing Address - Phone:707-803-0524
Mailing Address - Fax:
Practice Address - Street 1:28160 MCBEAN PKWY
Practice Address - Street 2:APT 7302
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1119
Practice Address - Country:US
Practice Address - Phone:707-803-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker