Provider Demographics
NPI:1700084464
Name:HOLLAND, MARIAN C (MD)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:C
Last Name:HOLLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-554-7797
Mailing Address - Fax:
Practice Address - Street 1:10666 N TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1027
Practice Address - Country:US
Practice Address - Phone:858-554-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1857207RC0000X
CAA100523207RC0001X, 207RC0000X, 207RC0001X, 207RC0000X
CODR.0069512207RC0000X, 207RC0001X
TXQ0070207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX522517YNGSOtherMEDICARE - TARRANT
TX361621101Medicaid
TX522517YL7AOtherMEDICARE - OTHER
TX522517YL7BOtherMEDICARE - DALLAS
TX522517YL7AOtherMEDICARE - OTHER