Provider Demographics
NPI:1558868505
Name:HOLLIE, EBONY
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:HOLLIE
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 1:1563 MISSION ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2592
Mailing Address - Country:US
Mailing Address - Phone:415-762-3700
Mailing Address - Fax:
Practice Address - Street 1:1202 MARINER DR UNIT C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94130-1210
Practice Address - Country:US
Practice Address - Phone:415-632-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker