Healthcare Provider Details

I. General information

NPI: 1235227984
Provider Name (Legal Business Name): RANDOLPH P. HOLMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 E. WHITTIER BLVD
WHITTIER CA
90603-2347
US

IV. Provider business mailing address

PO BOX 1277
WHITTIER CA
90609-1277
US

V. Phone/Fax

Practice location:
  • Phone: 562-947-8478
  • Fax: 562-943-5179
Mailing address:
  • Phone: 562-906-6470
  • Fax: 562-946-9465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG42202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: