Provider Demographics
NPI:1982722716
Name:HOLLAN, CAROL ANGELA (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANGELA
Last Name:HOLLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:STE 380
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-450-0440
Mailing Address - Fax:858-452-4341
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:STE 380
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-450-0440
Practice Address - Fax:858-452-4341
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC35984208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B50683Medicare UPIN
CAC35984Medicare ID - Type Unspecified