Provider Demographics
NPI:1922314426
Name:HOLDER, LA NITA DAY
Entity Type:Individual
Prefix:
First Name:LA NITA
Middle Name:DAY
Last Name:HOLDER
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 1:15405 LANSDOWNE RD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-0200
Mailing Address - Country:US
Mailing Address - Phone:805-998-0711
Mailing Address - Fax:
Practice Address - Street 1:15405 LANSDOWNE RD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-0200
Practice Address - Country:US
Practice Address - Phone:805-998-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124100383Medicaid