Provider Demographics
NPI:1821594680
Name:HOLT, MICHAEL EARL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EARL
Last Name:HOLT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1727
Mailing Address - Country:US
Mailing Address - Phone:415-452-2200
Mailing Address - Fax:415-334-5712
Practice Address - Street 1:1701 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1727
Practice Address - Country:US
Practice Address - Phone:415-452-2200
Practice Address - Fax:415-334-5712
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD5460663OtherCALIFORNIA ID CARD