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NPI Code Detail

MEDICARE: HOLLY SPOHN-GROSS DPM

MEDICARE: HOLLY SPOHN-GROSS DPM
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
1213E00000XPodiatristE4349CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1E4349OTHERCASTATE LICENSE
2213E00000XOTHERCATAXONOMY

General Provider Information

NPI Number : 1659453611
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY SPOHN-GROSS DPM
Provider Business Mailing Address
First Line : 6425 LYNCH CANYON DR
Second Line :
City : LAKE ISABELLA
State : CA
Zip : 93240-9726
Country : US
Telephone Number : 760-379-8630
Fax Number : 760-379-7658
Provider Business Practice Location Address
First Line : 6425 LYNCH CANYON DR
Second Line :
City : LAKE ISABELLA
State : CA
Zip : 93240-9726
Country : US
Telephone Number : 760-379-8630
Fax Number : 760-379-7658
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 01/18/2024

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Directions to “ HOLLY SPOHN-GROSS DPM” Practice Location

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