Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 16413 | CA |
NPI | 1255497210 |
---|---|
Provider Name | Dr. Douglas Holtzinger |
First Address | Hermosa Beach, CA 90254-4000 |
Second Address | Hermosa Beach, CA 90254-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
84-0928203 | TAX ID (01) | CA |