Healthcare Provider Details

I. General information

NPI: 1659711752
Provider Name (Legal Business Name): WHITNEY NICOLE HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S TUSTIN ST
ORANGE CA
92866-2550
US

IV. Provider business mailing address

1445 W VALENCIA ST
RIALTO CA
92376-3871
US

V. Phone/Fax

Practice location:
  • Phone: 714-289-3936
  • Fax:
Mailing address:
  • Phone: 909-279-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number36269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: