Provider Demographics
NPI:1942676663
Name:HOLMAN, JENNIFER CHAQUINGA (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHAQUINGA
Last Name:HOLMAN
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 1:3110 CHINO AVE STE 150A
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1295
Mailing Address - Country:US
Mailing Address - Phone:909-630-7490
Mailing Address - Fax:909-469-2108
Practice Address - Street 1:3110 CHINO AVE STE 150A
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1295
Practice Address - Country:US
Practice Address - Phone:909-630-7490
Practice Address - Fax:909-469-2108
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942676663Medicaid
CA52906OtherPA LICENSE