Healthcare Provider Details

I. General information

NPI: 1275757403
Provider Name (Legal Business Name): BEN BUCHHOLTZ M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LONG BEACH BLVD SUITE 200
LONG BEACH CA
90807-2696
US

IV. Provider business mailing address

4100 LONG BEACH BLVD SUITE 200
LONG BEACH CA
90807-2696
US

V. Phone/Fax

Practice location:
  • Phone: 310-348-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG44933
License Number StateCA

VIII. Authorized Official

Name: STEVEN GARRETT
Title or Position: BILLING MANAGER
Credential:
Phone: 310-348-0500