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NPI Code Detail

MEDICARE: KATHLEEN ANN HOLOYDA

MEDICARE: KATHLEEN ANN HOLOYDA
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
1208200000XPlastic Surgery PhysicianA129448CA
2208200000XPlastic Surgery Physician21257NV

General Provider Information

NPI Number : 1427348473
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN ANN HOLOYDA
Provider Business Mailing Address
First Line : 2170 SOUTH AVE
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-7026
Country : US
Telephone Number : 530-541-3420
Fax Number :
Provider Business Practice Location Address
First Line : 2175 SOUTH AVE
Second Line :
City : SOUTH LAKE TAHOE
State : CA
Zip : 96150-7024
Country : US
Telephone Number : 530-543-5799
Fax Number : 530-542-2872
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2011
Last Update Date : 12/23/2025

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Directions to “ KATHLEEN ANN HOLOYDA ” Practice Location

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