Healthcare Provider Details

I. General information

NPI: 1699816256
Provider Name (Legal Business Name): WILLIAM DAVID HOLDER PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MAIN ST STE 100
EL CAJON CA
92020-3325
US

IV. Provider business mailing address

34800 BOB WILSON DR NMCSD ATTN MEDICAL
SAN DIEGO CA
92134-1098
US

V. Phone/Fax

Practice location:
  • Phone: 619-401-0404
  • Fax:
Mailing address:
  • Phone: 619-532-6460
  • Fax: 619-532-6299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: