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General NPI Number Information
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NPI Number | 1194772822
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Entity Type | Individual
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Provider Name | KRISTINA A HOLMKVIST M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 08/17/2012
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Provider Practice Location Address
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Address Line | 301 W BASTANCHURY ROAD SUITE 245
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City | FULLERTON
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State | CA
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Zip | 92835
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Country | US
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Telephone | 714-525-3500
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Fax | 714-525-3588
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Provider Business Mailing Address
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Address Line | PO BOX 5859
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City | FULLERTON
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State | CA
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Zip | 92838-0859
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Country | US
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Telephone | 714-525-3500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 154016
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G83149
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License Number State | CA
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