Healthcare Provider Details

I. General information

NPI: 1528249596
Provider Name (Legal Business Name): JOHN D HOLLINGSEAD CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S HALCYON RD STE. 104
ARROYO GRANDE CA
93420-3872
US

IV. Provider business mailing address

8260 MORRO RD
ATASCADERO CA
93422-3954
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-9666
  • Fax: 805-466-9504
Mailing address:
  • Phone: 805-466-1296
  • Fax: 805-466-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: