Healthcare Provider Details

I. General information

NPI: 1376280941
Provider Name (Legal Business Name): DAWN HOLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E PALMDALE BLVD STE 211
PALMDALE CA
93550-4750
US

IV. Provider business mailing address

3605 E AVENUE R10
PALMDALE CA
93550-5757
US

V. Phone/Fax

Practice location:
  • Phone: 661-208-4699
  • Fax:
Mailing address:
  • Phone: 626-409-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: