Healthcare Provider Details

I. General information

NPI: 1982226205
Provider Name (Legal Business Name): MADISON KAWEHELANI HOLTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24910 LAS BRISAS RD STE 105
MURRIETA CA
92562-4010
US

IV. Provider business mailing address

8 CORTE CERVATI
LAKE ELSINORE CA
92532-0217
US

V. Phone/Fax

Practice location:
  • Phone: 951-231-1385
  • Fax:
Mailing address:
  • Phone: 808-542-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: