MEDICARE: JAMES VINCENT HOLMES RN

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	163W00000X	Registered Nurse	533597	CA

General Provider Information

NPI Number	:	1306552716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES VINCENT HOLMES RN

Provider Business Mailing Address
First Line	:	2355 BRANT ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-1301
Country	:	US
Telephone Number	:	619-995-4133
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 RIDGEHAVEN CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1686
Country	:	US
Telephone Number	:	619-694-7321
Fax Number	:

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

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	01/30/2023

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