Provider Demographics
NPI:1952759763
Name:HOLLINSID, JULIETTE
Entity type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:HOLLINSID
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 1:249 S ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7415
Mailing Address - Country:US
Mailing Address - Phone:619-307-7447
Mailing Address - Fax:
Practice Address - Street 1:343 HUNTER ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-7415
Practice Address - Country:US
Practice Address - Phone:760-789-0571
Practice Address - Fax:760-789-0577
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility