Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | G52483 | CA |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | G52483 | CA |
NPI | 1225300635 |
---|---|
Provider Name | Dr. Robert R Kutzner |
First Address | Newport Beach, CA 92660-3500 |
Second Address | Tustin, CA 92780-6026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2012 |
Last Update Date | 27/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1518207596 | (05) | CA |
B57939 | (02) | CA |