Provider Demographics
NPI:1629270368
Name:HOLMES, ANGELIQUE JUSTINE
Entity Type:Individual
Prefix:MS
First Name:ANGELIQUE
Middle Name:JUSTINE
Last Name:HOLMES
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 1:258 W A ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4850
Mailing Address - Country:US
Mailing Address - Phone:510-732-5956
Mailing Address - Fax:510-732-5954
Practice Address - Street 1:258 W A ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4850
Practice Address - Country:US
Practice Address - Phone:510-732-5956
Practice Address - Fax:510-732-5954
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator