Provider Demographics
NPI:1184637605
Name:RAUSCH, HOLLY LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LOUISE
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1240 S WESTLAKE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1929
Mailing Address - Country:US
Mailing Address - Phone:805-495-0551
Mailing Address - Fax:805-496-8079
Practice Address - Street 1:1240 S WESTLAKE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1929
Practice Address - Country:US
Practice Address - Phone:805-495-0551
Practice Address - Fax:805-496-8079
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95019207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184637605OtherNPI
CAWA95019AMedicare UPIN