Provider Demographics
NPI:1619914967
Name:HOLCOMB, DANA GRENIER (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:GRENIER
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:JO
Other - Last Name:GRENIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:910 VIA DE LA PAZ
Mailing Address - Street 2:STE 205
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3515
Mailing Address - Country:US
Mailing Address - Phone:310-454-5555
Mailing Address - Fax:310-454-0492
Practice Address - Street 1:910 VIA DE LA PAZ
Practice Address - Street 2:STE 205
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3515
Practice Address - Country:US
Practice Address - Phone:310-454-5555
Practice Address - Fax:310-454-0492
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG058395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10654Medicare ID - Type Unspecified
CAE02843Medicare UPIN