Provider Demographics
NPI:1336174911
Name:HOLMES, LOUIS I (PA)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:I
Last Name:HOLMES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SAN PABLO ST
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5310
Mailing Address - Country:US
Mailing Address - Phone:323-442-6878
Mailing Address - Fax:323-442-5956
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 4300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-6878
Practice Address - Fax:323-442-5956
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10462208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PA104620OtherBLUE SHIELD PROV. NUMBER
CA00PA104620Medicaid
CA00PA104620Medicaid
CA00PA104620OtherBLUE SHIELD PROV. NUMBER