Provider Demographics
NPI:1669115366
Name:SPITZ, CLARISSA (NP)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:SPITZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 N TURNER AVE APT 62
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5304
Mailing Address - Country:US
Mailing Address - Phone:626-940-6357
Mailing Address - Fax:
Practice Address - Street 1:17236 SATICOY ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2103
Practice Address - Country:US
Practice Address - Phone:818-600-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner