Provider Demographics
NPI:1962932384
Name:HAITZ, KARYN
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:HAITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 INNOVATION DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5997
Mailing Address - Country:US
Mailing Address - Phone:562-430-4294
Mailing Address - Fax:562-493-3573
Practice Address - Street 1:3772 KATELLA AVE STE 206
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6428
Practice Address - Country:US
Practice Address - Phone:562-430-4294
Practice Address - Fax:562-493-3573
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA271832207R00000X
CAA175492207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine