Healthcare Provider Details

I. General information

NPI: 1306491303
Provider Name (Legal Business Name): PAMELA MICHELLE HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 LOYOLA DR
SAN BERNARDINO CA
92407-3362
US

IV. Provider business mailing address

1577 LOYOLA DR
SAN BERNARDINO CA
92407-3362
US

V. Phone/Fax

Practice location:
  • Phone: 951-565-2058
  • Fax:
Mailing address:
  • Phone: 951-565-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: