Healthcare Provider Details

I. General information

NPI: 1164855920
Provider Name (Legal Business Name): KENDRA BELL HOLMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 BROADWAY ST STE 218
REDWOOD CITY CA
94063-3127
US

IV. Provider business mailing address

390 40TH ST
OAKLAND CA
94609-2633
US

V. Phone/Fax

Practice location:
  • Phone: 877-264-6747
  • Fax: 877-539-7730
Mailing address:
  • Phone: 510-653-5040
  • Fax: 510-653-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-26541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: