Provider Demographics
NPI:1821035585
Name:KATZ, JEFFERY S (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:S
Last Name:KATZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 N HARBOR BLV
Mailing Address - Street 2:STE 800
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4142
Mailing Address - Country:US
Mailing Address - Phone:714-473-8967
Mailing Address - Fax:714-440-4397
Practice Address - Street 1:1440 N HARBOR BLV
Practice Address - Street 2:STE 800
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4142
Practice Address - Country:US
Practice Address - Phone:714-473-8967
Practice Address - Fax:866-440-4397
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11468103G00000X, 103TC0700X
CAPSY00011468103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W19509Medicare PIN
CAR16504Medicare UPIN
CAWCP11468CMedicare ID - Type Unspecified
CAWCP11468BMedicare PIN
CAWCP11468DMedicare ID - Type Unspecified