Provider Demographics
NPI:1114383965
Name:CHOLLAR, LINDA IRENE
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:IRENE
Last Name:CHOLLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N JUANITA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2929
Mailing Address - Country:US
Mailing Address - Phone:310-318-3353
Mailing Address - Fax:
Practice Address - Street 1:515 N JUANITA AVE APT 4
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-2929
Practice Address - Country:US
Practice Address - Phone:310-318-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-10
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1911172M00000X
CAB01052173C00000X
CA1017174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator