HOLLY MEDICAL CLINIC LLC

Provider Demographics

• NPI: 1992594766
• Name: HOLLY MEDICAL CLINIC LLC
• Entity type: Organization
• Organization Name: HOLLY MEDICAL CLINIC LLC
• Authorized Official - Title/Position: OWNER
• Authorized Official - First Name: IVELICE
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: LOZANO OLIVER
• Authorized Official - Phone: 786-755-2953
• Mailing Address - Street 1: 959 SW 122ND AVE
• Mailing Address - City: MIAMI
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33184-2406
• Mailing Address - Country: US
• Mailing Address - Phone: 786-755-2953
• Mailing Address - Fax: 786-817-2341
• Practice Address - Street 1: 959 SW 122ND AVE
• Practice Address - City: MIAMI
• Practice Address - State: FL
• Practice Address - Zip Code: 33184-2406
• Practice Address - Country: US
• Practice Address - Phone: 786-755-2953
• Practice Address - Fax: 786-817-2341
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2025-05-06
• Last Update Date: 2025-06-18

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	208D00000X	Allopathic & Osteopathic Physicians	General Practice		Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	225X00000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist		Group - Multi-Specialty
No	225XM0800X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist	Mental Health	Group - Multi-Specialty
No	261Q00000X	Ambulatory Health Care Facilities	Clinic/Center		Group - Multi-Specialty
No	261QM0850X	Ambulatory Health Care Facilities	Clinic/Center	Adult Mental Health	Group - Multi-Specialty
No	261QP2000X	Ambulatory Health Care Facilities	Clinic/Center	Physical Therapy	Group - Multi-Specialty
No	364SP0808X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health	Group - Multi-Specialty
No	364SP0809X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health, Adult	Group - Multi-Specialty