=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740807080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIANA KATSMAN MD PHD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2020
-----------------------------------------------------
Last Update Date | 04/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3446 ALGINET DR
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-748-4579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3446 ALGINET DR
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-748-4579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO AND FOUNDER
-----------------------------------------------------
Name | DR. DIANA KATSMAN
-----------------------------------------------------
Credential | MD PHD
-----------------------------------------------------
Telephone | 310-748-4579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207WX0108X
-----------------------------------------------------
Taxonomy Name | Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------