Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC19151 | CA |
NPI | 1275533200 |
---|---|
Provider Name | Charina L Holmes |
First Address | Monterey Park, CA 91754-7120 |
Second Address | Monterey Park, CA 91754-7120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2005 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC01091510 | BLUE CROSS (01) | CA |
U16934 | (02) | CA |