1033443890 NPI number — ANNA-LORRAINE GONZAGA HOLLEY OTR/L, C/NDT

Table of content: ANNA-LORRAINE GONZAGA HOLLEY OTR/L, C/NDT (NPI 1033443890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033443890 NPI number — ANNA-LORRAINE GONZAGA HOLLEY OTR/L, C/NDT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLEY
Provider First Name:
ANNA-LORRAINE
Provider Middle Name:
GONZAGA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, C/NDT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZAGA
Provider Other First Name:
ANNA-LORRAINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033443890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15701 CANON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHINO HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91709-5247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-282-0231
Provider Business Mailing Address Fax Number:
909-606-9182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15454 GALE AVE
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
HACIENDA HEIGHTS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91745-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-330-1538
Provider Business Practice Location Address Fax Number:
626-239-1868
Provider Enumeration Date:
09/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  OT 1262 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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