Provider Demographics
NPI:1538584537
Name:LUTRICK, KIRSTEN (RN)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:LUTRICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26835 OLD HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:GUATAY
Mailing Address - State:CA
Mailing Address - Zip Code:91931-3101
Mailing Address - Country:US
Mailing Address - Phone:619-397-6901
Mailing Address - Fax:
Practice Address - Street 1:730 MEDICAL CENTER CT
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6618
Practice Address - Country:US
Practice Address - Phone:619-397-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA786806163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse