Provider Demographics
NPI:1407936248
Name:KATZ, EVA ECKFELD (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:ECKFELD
Last Name:KATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BRYAN AVE
Mailing Address - Street 2:STE E
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4401
Mailing Address - Country:US
Mailing Address - Phone:949-651-1475
Mailing Address - Fax:949-651-0126
Practice Address - Street 1:1101 BRYAN AVE
Practice Address - Street 2:STE E
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4401
Practice Address - Country:US
Practice Address - Phone:562-981-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85631Medicare UPIN
CAA41445Medicare ID - Type Unspecified