Healthcare Provider Details

I. General information

NPI: 1164346128
Provider Name (Legal Business Name): HOLLY MERSY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 LA COSTA MEADOWS DR STE 250
SAN MARCOS CA
92078-2156
US

IV. Provider business mailing address

930 ANZA AVE
VISTA CA
92084-4512
US

V. Phone/Fax

Practice location:
  • Phone: 760-516-8900
  • Fax:
Mailing address:
  • Phone: 760-224-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: