Healthcare Provider Details

I. General information

NPI: 1497600738
Provider Name (Legal Business Name): SAVANNAH HAILEY HOLSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3189 AIRWAY AVE STE A
COSTA MESA CA
92626-4612
US

IV. Provider business mailing address

3735 OSLO CT
HEMET CA
92545-2392
US

V. Phone/Fax

Practice location:
  • Phone: 714-881-0427
  • Fax: 714-881-0427
Mailing address:
  • Phone: 951-426-5824
  • Fax: 951-426-5824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: