Provider Demographics
NPI:1629196126
Name:HOLLOWAY, ERIN K (LAC)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:K
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 W REDONDO BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-2104
Mailing Address - Country:US
Mailing Address - Phone:310-963-1210
Mailing Address - Fax:
Practice Address - Street 1:3620 LONG BEACH BLVD STE C11
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-6016
Practice Address - Country:US
Practice Address - Phone:310-963-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8012171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist