Healthcare Provider Details

I. General information

NPI: 1003230814
Provider Name (Legal Business Name): JENNA EVE HOLMEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

IV. Provider business mailing address

400 W PUEBLO ST
SANTA BARBARA CA
93105-4353
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-7111
  • Fax:
Mailing address:
  • Phone: 805-682-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number128679
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60575925
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberA128679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: