Provider Demographics
NPI:1649276577
Name:KATZ, RONALD LOUISE (M D)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LOUISE
Last Name:KATZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 PLACENTIA AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3302
Mailing Address - Country:US
Mailing Address - Phone:949-645-3532
Mailing Address - Fax:949-645-3985
Practice Address - Street 1:355 PLACENTIA AVE
Practice Address - Street 2:STE 208
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3302
Practice Address - Country:US
Practice Address - Phone:949-645-3532
Practice Address - Fax:949-645-3985
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31015208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44635Medicare UPIN
CAG31015Medicare ID - Type UnspecifiedMEDICARE PROVIDER #