Provider Demographics
NPI:1518987585
Name:HOLSTEIN, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HOLSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CLYDE
Other - Middle Name:DAVID
Other - Last Name:HOLSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 17957
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-7957
Mailing Address - Country:US
Mailing Address - Phone:714-730-0311
Mailing Address - Fax:714-707-4762
Practice Address - Street 1:1211 W LA PALMA AVE STE 710
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2814
Practice Address - Country:US
Practice Address - Phone:714-730-0311
Practice Address - Fax:714-922-8093
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC322772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34879Medicare UPIN