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Provider Information for 1386983708


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Dr. JUSTIN CHRISTOPHER LUTZ PsyD


Sex: Male

NPI: 1386983708
Last Updated: 2020-08-20
Certification Date: 2020-08-20

Details

NameValue
NPI1386983708
Enumeration Date2013-02-05
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 301 THE CITY DRIVE
MOB44 2ND FLOOR
ORANGE, CA 92868
United States

Phone: 949-680-6791 | Fax:
 
Primary Practice Address 63 CARRIAGE HILL LN
LAGUNA HILLS, CA 92653-6039
United States

Phone: 949-680-6791 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 103T00000X - Psychologist CA31972