Provider Demographics
NPI:1093245250
Name:KATZ, REBECCA IZA (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:IZA
Last Name:KATZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 RIO RD STE 111
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8671
Mailing Address - Country:US
Mailing Address - Phone:831-293-7300
Mailing Address - Fax:940-301-3944
Practice Address - Street 1:3771 RIO RD STE 111
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8671
Practice Address - Country:US
Practice Address - Phone:831-293-7300
Practice Address - Fax:940-301-3944
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00648782084P0804X
PAMT214439390200000X
CAA1834542084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT214439OtherPENNSYLVANIA STATE BOARD OF MEDICINE