Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G6198 | CA |
NPI | 1003042706 |
---|---|
Provider Name | Dr. Harold Kravitz |
First Address | Costa Mesa, CA 92626-4835 |
Second Address | Costa Mesa, CA 92626-4835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 09/06/2009 |