Provider Demographics
NPI:1538219613
Name:KESTUTIS V. KURAITIS, M.D., PH.D., INC.
Entity type:Organization
Organization Name:KESTUTIS V. KURAITIS, M.D., PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KESTUTIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:KURAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-351-2626
Mailing Address - Street 1:PO BOX 651
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-0651
Mailing Address - Country:US
Mailing Address - Phone:760-351-2626
Mailing Address - Fax:760-351-2617
Practice Address - Street 1:751 W LEGION RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7732
Practice Address - Country:US
Practice Address - Phone:760-351-2626
Practice Address - Fax:760-351-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0086660Medicaid
CAW14697Medicare PIN