Basic Information
Provider Information
NPI: 1790756518
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PRINTZ
FirstName: BETH
MiddleName: J.F.
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3860 CALLE FORTUNADA
Address2: STE #210
City: SAN DIEGO
State: CA
PostalCode: 921234802
CountryCode: US
TelephoneNumber: 8583096303
FaxNumber: 8583096301
Practice Location
Address1: 8001 FROST ST
Address2: ENTRANCE 9
City: SAN DIEGO
State: CA
PostalCode: 921232746
CountryCode: US
TelephoneNumber: 8589665855
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/30/2006
LastUpdateDate: 09/19/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0202XG88440CAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
208000000XG88440CAN Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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