Provider Demographics
NPI:1063481976
Name:BRACHT, HOLGER ERNST (DO)
Entity Type:Individual
Prefix:
First Name:HOLGER
Middle Name:ERNST
Last Name:BRACHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 VERDUGO BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1421
Mailing Address - Country:US
Mailing Address - Phone:818-790-1145
Mailing Address - Fax:
Practice Address - Street 1:1818 VERDUGO BLVD STE 401
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1421
Practice Address - Country:US
Practice Address - Phone:818-790-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64705Medicare UPIN