Healthcare Provider Details

I. General information

NPI: 1558478941
Provider Name (Legal Business Name): MARK LEONARD KATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST MAILCODE #006/116A - MENTAL HEALTH CG
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E 7TH ST MAILCODE #006/116A - MENTAL HEALTH CG
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-826-5431
Mailing address:
  • Phone: 562-826-8000
  • Fax: 562-826-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG 62277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: