Healthcare Provider Details

I. General information

NPI: 1437067493
Provider Name (Legal Business Name): CHRISTOPHER HOLLOWAY PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S LONE HILL AVE
SAN DIMAS CA
91773-3536
US

IV. Provider business mailing address

700 S LONE HILL AVE
SAN DIMAS CA
91773-3536
US

V. Phone/Fax

Practice location:
  • Phone: 909-971-8270
  • Fax:
Mailing address:
  • Phone: 909-971-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220121078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: