Provider Demographics
NPI:1275533200
Name:HOLMES, CHARINA L (DC)
Entity Type:Individual
Prefix:
First Name:CHARINA
Middle Name:L
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 W POMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7120
Mailing Address - Country:US
Mailing Address - Phone:323-728-3101
Mailing Address - Fax:323-728-7284
Practice Address - Street 1:257 W POMONA BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-7120
Practice Address - Country:US
Practice Address - Phone:323-728-3101
Practice Address - Fax:323-728-7284
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19151111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC01091510OtherBLUE CROSS
CAU16934Medicare UPIN
CAAP722ZMedicare PIN