Healthcare Provider Details

I. General information

NPI: 1497803431
Provider Name (Legal Business Name): MARIANNE C KATZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6942 UNIVERSITY AVE STE A
LA MESA CA
91942
US

IV. Provider business mailing address

6942 UNIVERSITY AVE STE A
LA MESA CA
91942-5963
US

V. Phone/Fax

Practice location:
  • Phone: 619-698-2184
  • Fax: 619-698-2084
Mailing address:
  • Phone: 619-698-2184
  • Fax: 619-698-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP3818
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number336904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: