Healthcare Provider Details

I. General information

NPI: 1992530661
Provider Name (Legal Business Name): HOLLY L HOTTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1024
LUCERNE CA
95458-1024
US

IV. Provider business mailing address

7000B S CENTER DR
CLEARLAKE CA
95422-8131
US

V. Phone/Fax

Practice location:
  • Phone: 707-274-9101
  • Fax: 707-274-9192
Mailing address:
  • Phone: 707-274-9101
  • Fax: 707-274-9192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: