Provider Demographics
NPI:1598999211
Name:REKOW, HOLLY ANNE (HOLLY REKOW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANNE
Last Name:REKOW
Suffix:
Gender:F
Credentials:HOLLY REKOW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1502
Mailing Address - Country:US
Mailing Address - Phone:650-438-9097
Mailing Address - Fax:
Practice Address - Street 1:48 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1502
Practice Address - Country:US
Practice Address - Phone:650-438-9097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver