Provider Demographics
NPI:1134512023
Name:HOLMGREN, JANA DALENE
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:DALENE
Last Name:HOLMGREN
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 1:29157 SIERRA GOLD CIR
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7667
Mailing Address - Country:US
Mailing Address - Phone:909-648-5814
Mailing Address - Fax:
Practice Address - Street 1:29157 SIERRA GOLD CIR
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7667
Practice Address - Country:US
Practice Address - Phone:909-648-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 514224Z00000X
CANBCOT 1040174224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant