Provider Demographics
NPI:1902682131
Name:DRITLEIN, KURT DILLON (DNP, MSN, MBA, BSN)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:DILLON
Last Name:DRITLEIN
Suffix:
Gender:M
Credentials:DNP, MSN, MBA, BSN
Other - Prefix:
Other - First Name:KURT
Other - Middle Name:DILLON
Other - Last Name:DRITLEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, MSN, MBA, BSN
Mailing Address - Street 1:23972 BLUE RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2941
Mailing Address - Country:US
Mailing Address - Phone:951-796-7936
Mailing Address - Fax:
Practice Address - Street 1:1894 COMMERCENTER W STE 106
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3310
Practice Address - Country:US
Practice Address - Phone:909-333-7448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027032363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care