Healthcare Provider Details

I. General information

NPI: 1871068353
Provider Name (Legal Business Name): EMISHIANNA MARY HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24863 W JAYNE AVE
COALINGA CA
93210-9502
US

IV. Provider business mailing address

38713 TIERRA SUBIDA AVE # 344
PALMDALE CA
93551-4562
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-4900
  • Fax:
Mailing address:
  • Phone: 616-202-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: