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General NPI Number Information
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NPI Number | 1740953009
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Entity Type | Individual
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Provider Name | SHIALA HOLLAND
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Gender | Female
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Dates
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Enumeration Date | 07/31/2021
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Last Update Date | 07/31/2021
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Provider Practice Location Address
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Address Line | 16-2041 ANTHURIUM DR
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City | PAHOA
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State | HI
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Zip | 96778-7738
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Country | US
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Telephone | 510-701-6466
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Fax |
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Provider Business Mailing Address
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Address Line | 16-2041 ANTHURIUM DR
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City | PAHOA
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State | HI
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Zip | 96778-7738
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Country | US
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Telephone |
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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 | 374700000X
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Taxonomy Name | Technician
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License Number | RBT-21-162763
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License Number State | HI
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