MEDICARE: DR. KERRY JOHN HOLLENBECK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	A88891	CA

General Provider Information

NPI Number	:	1225018278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY JOHN HOLLENBECK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 25033
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92799-5033
Country	:	US
Telephone Number	:	714-347-1000
Fax Number	:	714-795-6829

Provider Business Practice Location Address
First Line	:	5176 HILL RD E
Second Line	:
City	:	LAKEPORT
State	:	CA
Zip	:	95453-6300
Country	:	US
Telephone Number	:	707-262-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/08/2024

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