Provider Demographics
NPI:1740274976
Name:KATZ, ALEJANDRO JOSE (OMD L AC)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:JOSE
Last Name:KATZ
Suffix:
Gender:M
Credentials:OMD L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5567 RESEDA BLVD.,
Mailing Address - Street 2:101
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:213-387-4710
Mailing Address - Fax:213-387-4811
Practice Address - Street 1:5567 RESEDA BLVD.,
Practice Address - Street 2:101
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:213-387-4710
Practice Address - Fax:213-387-4811
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2014-03-11
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
CAAC 2332171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist