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General NPI Number Information
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NPI Number | 1558627992
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Entity Type | Individual
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Provider Name | JOSEPH WAYNE HOLECKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 3315 WATT AVE
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City | SACRAMENTO
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State | CA
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Zip | 95821-3600
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Country | US
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Telephone | 916-481-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 410 W 10TH AVE N411 DOAN HALL
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City | COLUMBUS
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State | OH
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Zip | 43210-1240
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Country | US
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Telephone | 614-293-8487
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 35.122531
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A161027
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License Number State | CA
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