Healthcare Provider Details

I. General information

NPI: 1245674522
Provider Name (Legal Business Name): BRIAN KEITH HOLIWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N LAKEVIEW AVE
ANAHEIM CA
92807-3028
US

IV. Provider business mailing address

13052 SUTTON ST
CERRITOS CA
90703-8729
US

V. Phone/Fax

Practice location:
  • Phone: 714-279-4675
  • Fax:
Mailing address:
  • Phone: 562-404-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG52056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: