Healthcare Provider Details

I. General information

NPI: 1417330606
Provider Name (Legal Business Name): TIMOTHY E HOLLAND D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR STE 2
SAN DIEGO CA
92134-1002
US

IV. Provider business mailing address

PSC 3 BOX 3692
APO AP
96266-0037
US

V. Phone/Fax

Practice location:
  • Phone: 619-384-6400
  • Fax: 619-532-9458
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS14140
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS14140
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOS14140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: