Provider Demographics
NPI:1659043016
Name:HOLLAND, MELVIN JR (AGPCNP-BC)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:HOLLAND
Suffix:JR
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 BRAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4807
Mailing Address - Country:US
Mailing Address - Phone:562-310-9470
Mailing Address - Fax:
Practice Address - Street 1:6201 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-4661
Practice Address - Country:US
Practice Address - Phone:844-227-7599
Practice Address - Fax:855-227-7599
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95018201363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health