Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | G61204 | CA |
Y | 208000000X | Pediatrician | G61204 | CA |
N | 2080P0006X | Developmental - Behavioral Pediatrician | G61204 | CA |
NPI | 1114090461 |
---|---|
Provider Name | Mrs. Kathleen Ann Bretzius-Hurwitz |
First Address | Murrieta, CA 92562-9009 |
Second Address | Murrieta, CA 92562-9009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 28/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G61204 | STATE LICENSE (01) | CA |