Healthcare Provider Details

I. General information

NPI: 1205855889
Provider Name (Legal Business Name): MERCEDES LUCILLE HOLLAND OB/GYN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 WENTE WAY
SAN JOSE CA
95125
US

IV. Provider business mailing address

PO BOX 4756
SAN JOSE CA
95150-4756
US

V. Phone/Fax

Practice location:
  • Phone: 408-834-2174
  • Fax:
Mailing address:
  • Phone: 408-834-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number288655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: