Provider Demographics
NPI:1497803431
Name:KATZ, MARIANNE C (NP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:C
Last Name:KATZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6942 UNIVERSITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5963
Mailing Address - Country:US
Mailing Address - Phone:619-698-2184
Mailing Address - Fax:619-698-2084
Practice Address - Street 1:6942 UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-698-2184
Practice Address - Fax:619-698-2084
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP3818363L00000X
CA336904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497803431Medicaid