Provider Demographics
NPI:1760667455
Name:HOLMAN, DEVATARA J (MS, MA, LAC)
Entity Type:Individual
Prefix:
First Name:DEVATARA
Middle Name:J
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MS, MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38 CALEDONIA ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2117
Mailing Address - Country:US
Mailing Address - Phone:415-332-1013
Mailing Address - Fax:415-332-1013
Practice Address - Street 1:38 CALEDONIA ST STE 1
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2117
Practice Address - Country:US
Practice Address - Phone:415-332-1013
Practice Address - Fax:415-332-1013
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6550171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist