Healthcare Provider Details

I. General information

NPI: 1932860780
Provider Name (Legal Business Name): MADISON HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 PIERCE ST
RIVERSIDE CA
92505-4408
US

IV. Provider business mailing address

14336 GOLDEN CREST DR
CHINO HILLS CA
91709-4873
US

V. Phone/Fax

Practice location:
  • Phone: 909-435-5136
  • Fax:
Mailing address:
  • Phone: 909-214-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: