Provider Demographics
NPI:1083597157
Name:HOLIFIELD, KASI BROOKE (CPT)
Entity type:Individual
Prefix:
First Name:KASI
Middle Name:BROOKE
Last Name:HOLIFIELD
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W TEMPLE ST APT 320
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4546
Mailing Address - Country:US
Mailing Address - Phone:213-800-5242
Mailing Address - Fax:
Practice Address - Street 1:305 N FREMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4546
Practice Address - Country:US
Practice Address - Phone:213-800-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator