Provider Demographics
NPI:1912229048
Name:MARIE B BRITZ, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MARIE B BRITZ, M.D. A MEDICAL CORPORATION
Other - Org Name:MARIE B BRITZ M.D. A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-294-3200
Mailing Address - Street 1:2074 FOREST AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4811
Mailing Address - Country:US
Mailing Address - Phone:408-294-3200
Mailing Address - Fax:408-294-3202
Practice Address - Street 1:2074 FOREST AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4811
Practice Address - Country:US
Practice Address - Phone:408-294-3200
Practice Address - Fax:408-294-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG337540207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty