Provider Demographics
NPI:1780661900
Name:KATZ, ANDREW L (DPM)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:L
Last Name:KATZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 AUTO CENTER DR.
Mailing Address - Street 2:STE A
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4490
Mailing Address - Country:US
Mailing Address - Phone:661-273-3338
Mailing Address - Fax:661-273-3529
Practice Address - Street 1:847 AUTO CENTER DR
Practice Address - Street 2:STE A
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4490
Practice Address - Country:US
Practice Address - Phone:661-273-3338
Practice Address - Fax:661-273-3529
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4026213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40260Medicaid
CAU65135Medicare UPIN
CAE4026Medicare ID - Type Unspecified
CA000E40260Medicaid
CA4991720001Medicare NSC