Healthcare Provider Details

I. General information

NPI: 1194835058
Provider Name (Legal Business Name): LOUIS J KATZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 VIA REGLA
SAN DIEGO CA
92122-3924
US

IV. Provider business mailing address

6071 VIA REGLA
SAN DIEGO CA
92122-3924
US

V. Phone/Fax

Practice location:
  • Phone: 619-444-5917
  • Fax: 619-444-1740
Mailing address:
  • Phone: 858-457-1973
  • Fax: 619-615-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG27392
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG27392
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: