Healthcare Provider Details

I. General information

NPI: 1053773754
Provider Name (Legal Business Name): TESSINY IRIARTE HOLLIDAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45104 10TH ST W
LANCASTER CA
93534-2310
US

IV. Provider business mailing address

45104 10TH ST W
LANCASTER CA
93534-2310
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-2391
  • Fax:
Mailing address:
  • Phone: 661-942-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number95003939
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95003939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: