Healthcare Provider Details

I. General information

NPI: 1598040982
Provider Name (Legal Business Name): ZAKIYA HOLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 CORONA POINTE CT STE 102
CORONA CA
92879-1721
US

IV. Provider business mailing address

PO BOX 740780
ATLANTA GA
30374-0780
US

V. Phone/Fax

Practice location:
  • Phone: 951-254-7862
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12886439-2506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: