Healthcare Provider Details

I. General information

NPI: 1427340694
Provider Name (Legal Business Name): HOLLAND HOTHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17752 SKY PARK CIR STE 140
IRVINE CA
92614-4469
US

IV. Provider business mailing address

17752 SKY PARK CIR STE 140
IRVINE CA
92614-4469
US

V. Phone/Fax

Practice location:
  • Phone: 949-474-5577
  • Fax:
Mailing address:
  • Phone: 949-474-5577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-18210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: