Provider Demographics
NPI:1659492650
Name:HAMILTOPAUCAR, HOLLY LINN
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:LINN
Last Name:HAMILTOPAUCAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:LINN
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:380 S MELROSE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6641
Mailing Address - Country:US
Mailing Address - Phone:760-370-1300
Mailing Address - Fax:
Practice Address - Street 1:1098 CAMINO DEL SOL
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-7345
Practice Address - Country:US
Practice Address - Phone:760-295-4857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical