Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A117430 | CA |
N | 208200000X | Surgeon | A117430 | CA |
N | 208600000X | Surgeon | A117430 | CA |
N | 2086S0102X | Surgical Critical Care | A117430 | CA |
NPI | 1124223565 |
---|---|
Provider Name | David Warren Boldt |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2007 |
Last Update Date | 23/12/2019 |