Provider Demographics
NPI:1861439465
Name:HOLZNER, CHARLES M (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:HOLZNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-4020
Mailing Address - Country:US
Mailing Address - Phone:562-862-2384
Mailing Address - Fax:562-231-1904
Practice Address - Street 1:10000 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4020
Practice Address - Country:US
Practice Address - Phone:562-862-2384
Practice Address - Fax:562-231-1904
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45314207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G453140Medicaid
110060915OtherRAILROAD
00G453140OtherBLUE SHIELD ID #
045262OtherHEALTH NET ID #
P00361831OtherRAILROAD
110060915OtherRAILROAD
00G453140OtherBLUE SHIELD ID #
P00361831OtherRAILROAD