Healthcare Provider Details

I. General information

NPI: 1194563536
Provider Name (Legal Business Name): TARA HOLGATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S STATE COLLEGE BLVD STE 150
BREA CA
92821-5837
US

IV. Provider business mailing address

120 S STATE COLLEGE BLVD STE 150
BREA CA
92821-5837
US

V. Phone/Fax

Practice location:
  • Phone: 714-577-5400
  • Fax:
Mailing address:
  • Phone: 714-577-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: