Provider Demographics
NPI:1063492031
Name:HOLLAND, CHRISTOPHER VAUGHN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:VAUGHN
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1206
Mailing Address - Country:US
Mailing Address - Phone:805-540-0689
Mailing Address - Fax:805-541-4376
Practice Address - Street 1:1551 BISHOP ST STE 250
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4661
Practice Address - Country:US
Practice Address - Phone:805-540-0689
Practice Address - Fax:805-541-4376
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA84573207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI35182Medicare UPIN