Basic Information
| Provider Information | |||||||||
| NPI: | 1851300032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLTOM | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | LAC USC MEDICAL CENTER | ||||||||
| Address2: | 1200 N. STATE SE. ROOM C5E100 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234096645 | ||||||||
| FaxNumber: | 3234418250 | ||||||||
| Practice Location | |||||||||
| Address1: | 1520 SAN PABLO ST | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900335310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234425100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | G044895 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 00G448950197 | 01 | CA | CAL OPTIMA | OTHER | W18762 | 01 | CA | GROUP MEDICARE | OTHER | 00G448950 | 05 | CA | MEDICAID | 440000831 | 01 | CA | RAILROAD MEDICARE | OTHER | CE1617 | 01 | CA | GROUP RAILROAD MEDICARE | OTHER | 1902846306 | 01 | CA | GROUP NPI | OTHER | GR0016910 | 01 | CA | GROUP MEDICAID PIN | OTHER | W11675 | 01 | CA | GROUP MEDICARE PIN | OTHER | ZZZ50018Z | 01 | CA | GROUP BLUE SHIELD | OTHER | 00G448950 | 01 | CA | BLUE SHIELD | OTHER | 06E2774 | 01 | CA | GROUP CHAMPUS | OTHER | GR0100430 | 01 | CA | GROUP MEDICAL | OTHER | 1356390009 | 01 | CA | GROUP NPI | OTHER |