Provider Demographics
NPI:1790293496
Name:HOLCOMB, MADISON (PA-C)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 GROSSMONT CENTER DRIVE, BLDG. 3
Mailing Address - Street 2:SUITE 540
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3024
Mailing Address - Country:US
Mailing Address - Phone:619-460-2700
Mailing Address - Fax:619-460-2702
Practice Address - Street 1:5565 GROSSMONT CENTER DRIVE, BLDG. 3
Practice Address - Street 2:SUITE 540
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3024
Practice Address - Country:US
Practice Address - Phone:619-460-2700
Practice Address - Fax:619-460-2702
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS363AS0400X
CA59043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical