Provider Demographics
NPI:1376823021
Name:HOLM, ERIN A
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:A
Last Name:HOLM
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 1:788 S MAGNOLIA AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6125
Mailing Address - Country:US
Mailing Address - Phone:619-781-7988
Mailing Address - Fax:
Practice Address - Street 1:788 S MAGNOLIA AVE APT 6
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6125
Practice Address - Country:US
Practice Address - Phone:619-781-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMT1445225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist