Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 19355 | CA |
Y | 213EG0000X | General Practice | 19355 | CA |
NPI | 1003061193 |
---|---|
Provider Name | Dr. R. Bruce Kautz |
First Address | Van Nuys, CA 91401-4218 |
Second Address | Van Nuys, CA 91401-4218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 18/11/2008 |