Provider Demographics
NPI:1245479492
Name:HOLMES, CHRISTINE YUN
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:YUN
Last Name:HOLMES
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 1:1451 RIMPAU AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7522
Mailing Address - Country:US
Mailing Address - Phone:951-444-1736
Mailing Address - Fax:760-242-1425
Practice Address - Street 1:1451 RIMPAU AVE STE 215
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-7522
Practice Address - Country:US
Practice Address - Phone:951-444-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24648101YM0800X
101YM0800X
CALCSW747841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA820624740Medicaid