Healthcare Provider Details

I. General information

NPI: 1912087164
Provider Name (Legal Business Name): HOLLY D. HATT D.M.D., M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD SUITE 205
POWAY CA
92064-2068
US

IV. Provider business mailing address

15725 POMERADO RD SUITE 205
POWAY CA
92064-2068
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-0200
  • Fax: 858-451-0250
Mailing address:
  • Phone: 858-451-0200
  • Fax: 858-451-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA91989
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number53345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: