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General NPI Number Information
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NPI Number | 1821942194
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Entity Type | Individual
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Provider Name | KAYLA HOLOVACH
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Gender |
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Dates
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Enumeration Date | 02/24/2026
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Last Update Date | 02/24/2026
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Provider Practice Location Address
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Address Line | 1589 VALLE DE COLORES ST NW
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City | LOS LUNAS
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State | NM
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Zip | 87031-9158
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Country | US
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Telephone | 505-259-2657
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Fax |
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Provider Business Mailing Address
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Address Line | 1589 VALLE DE COLORES ST NW
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City | LOS LUNAS
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State | NM
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Zip | 87031-9158
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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 | 2081P0010X
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Taxonomy Name | Pediatric Rehabilitation Medicine Physician
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License Number | PT-2023-2065
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License Number State | NM
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