Healthcare Provider Details

I. General information

NPI: 1194967240
Provider Name (Legal Business Name): JOSHUA WALTZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 LONG BEACH BLVD STE 102
LONG BEACH CA
90807-2005
US

IV. Provider business mailing address

4251 LONG BEACH BLVD STE 102
LONG BEACH CA
90807-2005
US

V. Phone/Fax

Practice location:
  • Phone: 562-448-6100
  • Fax: 562-448-6101
Mailing address:
  • Phone: 562-448-6100
  • Fax: 562-448-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA128713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: