Healthcare Provider Details

I. General information

NPI: 1871610733
Provider Name (Legal Business Name): HOLTORF MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD #160
TORRANCE CA
90505-4716
US

IV. Provider business mailing address

23456 HAWTHORNE BLVD #160
TORRANCE CA
90505-4716
US

V. Phone/Fax

Practice location:
  • Phone: 310-375-2705
  • Fax:
Mailing address:
  • Phone: 310-375-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4644
License Number StateCA

VIII. Authorized Official

Name: DR. KENT HOLTORF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-375-1660