Healthcare Provider Details

I. General information

NPI: 1356633978
Provider Name (Legal Business Name): DENNIS R. HOLMES, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2011
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE
LOS ANGELES CA
90015-3021
US

IV. Provider business mailing address

5670 WILSHIRE BLVD STE 1740
LOS ANGELES CA
90036-5656
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-5784
  • Fax: 213-742-6055
Mailing address:
  • Phone: 714-522-2001
  • Fax: 714-522-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA68940
License Number StateCA

VIII. Authorized Official

Name: DR. DENNIS R HOLMES
Title or Position: OWNER
Credential: M.D.
Phone: 213-742-5784