Provider Demographics
NPI:1750575643
Name:HOLY, ADRIANA K
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:K
Last Name:HOLY
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ADRIANA
Other - Middle Name:K
Other - Last Name:HOLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4530 E SHEA BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6065
Mailing Address - Country:US
Mailing Address - Phone:602-867-7546
Mailing Address - Fax:608-971-0065
Practice Address - Street 1:4530 E SHEA BLVD
Practice Address - Street 2:101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6065
Practice Address - Country:US
Practice Address - Phone:602-867-7546
Practice Address - Fax:608-971-0065
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH2768957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist