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NPI Code Detail

MEDICARE: MRS. HOLLY DARLENE TOLLETTE THOMAS

MEDICARE:  MRS. HOLLY DARLENE TOLLETTE THOMAS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1649449521
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HOLLY DARLENE TOLLETTE THOMAS
Provider Business Mailing Address
First Line : 9150 IMPERIAL HWY
Second Line : ROOM P-31
City : DOWNEY
State : CA
Zip : 90242-2835
Country : US
Telephone Number : 562-940-3694
Fax Number : 562-658-4725
Provider Business Practice Location Address
First Line : 11234 VALLEY BLVD
Second Line : SUITE 302
City : EL MONTE
State : CA
Zip : 91731-3241
Country : US
Telephone Number : 626-575-4001
Fax Number : 626-443-1040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2008
Last Update Date : 02/26/2008

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Directions to “ MRS. HOLLY DARLENE TOLLETTE THOMAS ” Practice Location

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