Healthcare Provider Details

I. General information

NPI: 1861128035
Provider Name (Legal Business Name): RYAN JASON HOLLIDAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 MCMILLAN AVE STE 164
SAN LUIS OBISPO CA
93401-6768
US

IV. Provider business mailing address

2180 JOHNSON AVE # B
SAN LUIS OBISPO CA
93401-4558
US

V. Phone/Fax

Practice location:
  • Phone: 805-439-4890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number373H00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: