Healthcare Provider Details

I. General information

NPI: 1457488587
Provider Name (Legal Business Name): ROBERT PATRICK HOLLOWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 S SAN VICENTE BLVD SUITE 201
LOS ANGELES CA
90048-4650
US

IV. Provider business mailing address

8581 SANTA MONICA BLVD PMB 432
WEST HOLLYWOOD CA
90069-4120
US

V. Phone/Fax

Practice location:
  • Phone: 310-403-7878
  • Fax:
Mailing address:
  • Phone: 310-403-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA55346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: