Provider Demographics
NPI:1841474616
Name:HOLTS, ROBERTA NADINE
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:NADINE
Last Name:HOLTS
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 1:9150 E IMPERIAL HWY
Mailing Address - Street 2:ROOM P-31
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:91242
Mailing Address - Country:US
Mailing Address - Phone:562-940-3694
Mailing Address - Fax:562-658-4725
Practice Address - Street 1:200 W COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTOM
Practice Address - State:CA
Practice Address - Zip Code:90222
Practice Address - Country:US
Practice Address - Phone:310-603-7311
Practice Address - Fax:310-687-2966
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management