Provider Demographics
NPI:1326891227
Name:HOLLAND, CRYSTAL CAROLINE
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:CAROLINE
Last Name:HOLLAND
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 1:1550 DIABLO DR APT C
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5980
Mailing Address - Country:US
Mailing Address - Phone:831-673-9078
Mailing Address - Fax:
Practice Address - Street 1:1550 DIABLO DR APT C
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5980
Practice Address - Country:US
Practice Address - Phone:831-673-9078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty