MEDICARE: JAID P HOLMAN CMT

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	225700000X	Massage Therapist	102222	CA

General Provider Information

NPI Number	:	1811686090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAID P HOLMAN CMT

Provider Business Mailing Address
First Line	:	336 GARFIELD ST APT 3
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-3290
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 GARFIELD ST APT 3
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-3290
Country	:	US
Telephone Number	:	760-525-3891
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	04/13/2026

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