Healthcare Provider Details

I. General information

NPI: 1700988268
Provider Name (Legal Business Name): WILLIAM STEPHEN HOLTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 AVOCADO AVE
NEWPORT BEACH CA
92660-7725
US

IV. Provider business mailing address

10061 E IRONWOOD DR
SCOTTSDALE AZ
85258-4805
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-3025
  • Fax: 949-720-3944
Mailing address:
  • Phone: 480-797-0781
  • Fax: 949-720-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberG54674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: