Healthcare Provider Details

I. General information

NPI: 1093245250
Provider Name (Legal Business Name): REBECCA IZA KATZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 RIO RD STE 111
CARMEL CA
93923-8671
US

IV. Provider business mailing address

3771 RIO RD STE 111
CARMEL CA
93923-8671
US

V. Phone/Fax

Practice location:
  • Phone: 831-293-7300
  • Fax: 940-301-3944
Mailing address:
  • Phone: 831-293-7300
  • Fax: 940-301-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDR.0064878
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT214439
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA183454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: