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NPI Code Detail

MEDICARE: DEONTE HOLLOMON BA

MEDICARE: DEONTE HOLLOMON BA
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 : 1902988645
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEONTE HOLLOMON BA
Provider Business Mailing Address
First Line : 9505 GOLD COAST DR APT 144
Second Line :
City : SAN DIEGO
State : CA
Zip : 92126-3931
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1738 S TREMONT ST
Second Line :
City : OCEANSIDE
State : CA
Zip : 92054-5309
Country : US
Telephone Number : 760-439-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 11/19/2013

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Directions to “ DEONTE HOLLOMON BA” Practice Location

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