Provider Demographics
NPI:1912132044
Name:WILTZ, CLEVELAND
Entity Type:Individual
Prefix:MR
First Name:CLEVELAND
Middle Name:
Last Name:WILTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 HAMDER WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-9607
Mailing Address - Country:US
Mailing Address - Phone:757-890-0593
Mailing Address - Fax:
Practice Address - Street 1:162 DODD BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LANGLEY AFB
Practice Address - State:VA
Practice Address - Zip Code:23665-1916
Practice Address - Country:US
Practice Address - Phone:757-764-1299
Practice Address - Fax:757-225-9941
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other