Healthcare Provider Details

I. General information

NPI: 1093524365
Provider Name (Legal Business Name): BRANDON DARION DANTRIEL HOLLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 13TH STREET
MERCED CA
95341
US

IV. Provider business mailing address

301 E 13TH STREET
MERCED CA
95341
US

V. Phone/Fax

Practice location:
  • Phone: 209-385-7311
  • Fax:
Mailing address:
  • Phone: 209-385-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: