MEDICARE: DR. BERNARD J KATZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician	A45158	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W14560D	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1750317772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD J KATZ MD

Provider Business Mailing Address
First Line	:	5767 W. CENTURY BLVD
Second Line	:	400
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5655
Country	:	US
Telephone Number	:	310-417-5901
Fax Number	:	310-410-1001

Provider Business Practice Location Address
First Line	:	881 ALMA REAL DR
Second Line	:	214
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-3731
Country	:	US
Telephone Number	:	310-459-2363
Fax Number	:	310-459-1517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	03/25/2014

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Directions to “ DR. BERNARD J KATZ MD” Practice Location

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