=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396081733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. DIANE CHRISTINE HOLMES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2012
-----------------------------------------------------
Last Update Date | 05/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 PARNASSUS AVE UCSF MEDICAL CENTER
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-353-1756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1525 INTERNATIONAL PKWY
-----------------------------------------------------
City | HEATHROW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-7644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-798-6035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 13510
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------