Provider Demographics
NPI:1619091188
Name:HOLMES, RONALD ALAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALAN
Last Name:HOLMES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:ALAN
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:IGO
Mailing Address - State:CA
Mailing Address - Zip Code:96047-0128
Mailing Address - Country:US
Mailing Address - Phone:530-396-2748
Mailing Address - Fax:
Practice Address - Street 1:14515 SMALL FARMS RD
Practice Address - Street 2:
Practice Address - City:IGO
Practice Address - State:CA
Practice Address - Zip Code:96047
Practice Address - Country:US
Practice Address - Phone:530-396-2748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5334171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist