Provider Demographics
NPI:1083710669
Name:HOLMES, CHRISTOPHER KENNETH (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KENNETH
Last Name:HOLMES
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:27455 TIERRA ALTA WAY
Practice Address - Street 2:SUITE A
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3498
Practice Address - Country:US
Practice Address - Phone:951-699-5282
Practice Address - Fax:951-694-8652
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC303322083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP420ZMedicare PIN
CACP963ZMedicare PIN
CAG71419Medicare UPIN
CACP420XMedicare PIN