Provider Demographics
NPI:1184929408
Name:HOLLIS, MICHAEL JEFFEREY (ND)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEFFEREY
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 4TH ST
Mailing Address - Street 2:4
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2640
Mailing Address - Country:US
Mailing Address - Phone:310-728-6785
Mailing Address - Fax:
Practice Address - Street 1:933 4TH ST
Practice Address - Street 2:4
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2640
Practice Address - Country:US
Practice Address - Phone:310-728-6785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-198175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath