Healthcare Provider Details

I. General information

NPI: 1023246337
Provider Name (Legal Business Name): SANDRA D. KATZ RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 1/2 S SPALDING DR
BEVERLY HILLS CA
90212-3609
US

IV. Provider business mailing address

308 1/2 S SPALDING DR
BEVERLY HILLS CA
90212-3609
US

V. Phone/Fax

Practice location:
  • Phone: 310-291-2879
  • Fax:
Mailing address:
  • Phone: 310-291-2879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: