Healthcare Provider Details

I. General information

NPI: 1457655227
Provider Name (Legal Business Name): DUNYA ELLEN HOLLAND MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MAIN ST 101
RAMONA CA
92065-2170
US

IV. Provider business mailing address

1012 MAIN ST 101
RAMONA CA
92065-2170
US

V. Phone/Fax

Practice location:
  • Phone: 760-788-9724
  • Fax:
Mailing address:
  • Phone: 760-788-9724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number59496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: