Healthcare Provider Details

I. General information

NPI: 1750147120
Provider Name (Legal Business Name): 2020 VISION YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14241 FIRESTONE BLVD STE 225
LA MIRADA CA
90638-5533
US

IV. Provider business mailing address

967 KENDALL DR STE 332
SAN BERNARDINO CA
92407-4306
US

V. Phone/Fax

Practice location:
  • Phone: 213-691-2522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: CORY HOLLAMAN
Title or Position: CHIEF EXCUTIVE OFFICER
Credential:
Phone: 909-486-8690