Provider Demographics
NPI:1629570874
Name:SCHWARTZ, KATHERINE ELIZABETH
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 NEOLA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2406
Mailing Address - Country:US
Mailing Address - Phone:626-941-4844
Mailing Address - Fax:
Practice Address - Street 1:14422 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1439
Practice Address - Country:US
Practice Address - Phone:626-941-4844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102182122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist