Provider Demographics
NPI:1801105432
Name:BREIDING, HOLLY LYNN
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:LYNN
Last Name:BREIDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:L
Other - Last Name:LOPKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2632
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93240
Mailing Address - Country:US
Mailing Address - Phone:760-379-3412
Mailing Address - Fax:760-379-5332
Practice Address - Street 1:2731 NUGGET AVE
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240
Practice Address - Country:US
Practice Address - Phone:760-379-3412
Practice Address - Fax:760-379-5332
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program