1235383787 NPI number — MISS HOLLY MICHELLE MAUGHN BA

Table of content: MISS HOLLY MICHELLE MAUGHN BA (NPI 1235383787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235383787 NPI number — MISS HOLLY MICHELLE MAUGHN BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAUGHN
Provider First Name:
HOLLY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235383787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
532 E. COLORADO BLVD, 8TH FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-229-3818
Provider Business Mailing Address Fax Number:
626-793-6003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 E COLORADO BLVD FL 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91101-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-229-3818
Provider Business Practice Location Address Fax Number:
626-793-6003
Provider Enumeration Date:
11/11/2008

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: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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