Provider Demographics
NPI:1376877282
Name:RONALD L. KATZ, M. D., INC.
Entity Type:Organization
Organization Name:RONALD L. KATZ, M. D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:POULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-645-3532
Mailing Address - Street 1:355 PLACENTIA AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3311
Mailing Address - Country:US
Mailing Address - Phone:949-645-3532
Mailing Address - Fax:949-645-3985
Practice Address - Street 1:355 PLACENTIA AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3311
Practice Address - Country:US
Practice Address - Phone:949-645-3532
Practice Address - Fax:949-645-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31015208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G31015Medicare PIN
A44635Medicare UPIN