Basic Information
| Provider Information | |||||||||
| NPI: | 1902062151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATOUZIAN | ||||||||
| FirstName: | TAHER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38600 MEDICAL CENTER DR | ||||||||
| Address2: | STOP 9410 | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935514483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613825000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 38600 MEDICAL CENTER DR | ||||||||
| Address2: | STOP 9410 | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935514483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613825000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2008 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 20A12692 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | 20A12692 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.