Provider Demographics
NPI:1518206820
Name:HOLLY, LEGRAN (CAADE-IV)
Entity Type:Individual
Prefix:MS
First Name:LEGRAN
Middle Name:
Last Name:HOLLY
Suffix:
Gender:F
Credentials:CAADE-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 POST AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2620
Mailing Address - Country:US
Mailing Address - Phone:310-328-1460
Mailing Address - Fax:
Practice Address - Street 1:1334 POST AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2620
Practice Address - Country:US
Practice Address - Phone:310-328-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator