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General NPI Number Information
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NPI Number | 1861413387
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Entity Type | Individual
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Provider Name | HOLLY LEEDS MD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 152 CATHERINE LN STE F
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City | GRASS VALLEY
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State | CA
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Zip | 95945
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Country | US
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Telephone | 888-966-2398
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Fax | 844-235-8334
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Provider Business Mailing Address
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Address Line | 152 CATHERINE LN STE F
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City | GRASS VALLEY
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State | CA
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Zip | 95945-5756
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Country | US
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Telephone | 888-966-2398
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Fax | 844-235-8334
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 0G79232
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License Number State | CA
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