Healthcare Provider Details

I. General information

NPI: 1063327716
Provider Name (Legal Business Name): HOLLY ANN MAUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E CALLE LA GUERRA
CAMARILLO CA
93010-2716
US

IV. Provider business mailing address

600 TEMPLE AVE
CAMARILLO CA
93010-4835
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-5325
  • Fax:
Mailing address:
  • Phone: 805-389-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number260049135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: