Healthcare Provider Details

I. General information

NPI: 1053469981
Provider Name (Legal Business Name): MARK R. KATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12845 POINTE DEL MAR WAY SUITE 200
DEL MAR CA
92014-3862
US

IV. Provider business mailing address

12845 POINTE DEL MAR WAY SUITE 200
DEL MAR CA
92014-3862
US

V. Phone/Fax

Practice location:
  • Phone: 858-259-0599
  • Fax: 858-794-7218
Mailing address:
  • Phone: 858-259-0599
  • Fax: 858-794-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG39639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: