Individual
MR. ETHAN M KREISWIRTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, ATC
Contact information
Practice address
CAL STATE DOMINGUEZ HLS, 1000 E. VICTORIA ST., CARSON, CA 90747-0001
(310) 243-3894
Mailing address
5361 W 126TH ST, HAWTHORNE, CA 90250-4128
(310) 243-3894
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
09/24/2006
Last updated
07/08/2007
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