Healthcare Provider Details

I. General information

NPI: 1023168879
Provider Name (Legal Business Name): DIANE RENE HOLZER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 B STREET
POINT REYES STATION CA
94956
US

IV. Provider business mailing address

1455 N MCDOWELL BLVD STE D
PETALUMA CA
94954-6503
US

V. Phone/Fax

Practice location:
  • Phone: 415-663-8666
  • Fax:
Mailing address:
  • Phone: 707-559-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: