Basic Information
| Provider Information | |||||||||
| NPI: | 1619075421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATZ | ||||||||
| FirstName: | MERVYN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45104 10TH ST W | ||||||||
| Address2: | 300 | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619422391 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14091 RIMALDI | ||||||||
| Address2: | 300 | ||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183657783 | ||||||||
| FaxNumber: | 8183652193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 11/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G40288 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.