Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | G44933 | CA |
Y | 222Z00000X | Podiatrist | G44933 | CA |
NPI | 1013953041 |
---|---|
Provider Name | Ben Buchholtz |
First Address | Long Beach, CA 90807-2696 |
Second Address | Long Beach, CA 90807-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 08/07/2007 |