Provider Demographics
NPI:1760841894
Name:HOLTON, MEGHAN ALIECE
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ALIECE
Last Name:HOLTON
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 1:1733 N PALM CANYON DR STE C
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-2957
Mailing Address - Country:US
Mailing Address - Phone:760-848-8587
Mailing Address - Fax:
Practice Address - Street 1:1733 N PALM CANYON DR STE C
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-2957
Practice Address - Country:US
Practice Address - Phone:760-848-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66224173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist