Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 95003939 | CA |
Y | 207Q00000X | Family Doctor | 95003939 | CA |
NPI | 1053773754 |
---|---|
Provider Name | Tessiny Iriarte Holliday |
First Address | Lancaster, CA 93534-2310 |
Second Address | Lancaster, CA 93534-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 15/01/2021 |