Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G56005 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | G56005 | CA |
N | 207ND0900X | Dermatopathologist | G56005 | CA |
N | 207NS0135X | Procedural Dermatology | G56005 | CA |
NPI | 1275567323 |
---|---|
Provider Name | Holly Louise Christman |
First Address | Sausalito, CA 94965-2853 |
Second Address | Sausalito, CA 94965 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 20/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F38331 | (02) | CA |