Healthcare Provider Details

I. General information

NPI: 1851201164
Provider Name (Legal Business Name): JERRY LINN HOLLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 MIRAMAR RD STE 130
SAN DIEGO CA
92126-4561
US

IV. Provider business mailing address

1651 S JUNIPER ST UNIT 52
ESCONDIDO CA
92025-6152
US

V. Phone/Fax

Practice location:
  • Phone: 858-527-0232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: