NPI |
1629637640 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
ALLISON A HOLTKAMP, PSYD PSYCHOLOGIST INC |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
17744 SKY PARK CIR STE 285 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
IRVINE |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
CA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
926144461 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
7149147794 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
6/12/2019 |
The telephone number associated with the location address of the provider being identified. |
Last Update Date |
6/12/2019 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Last Name |
HOLTKAMP |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
ALLISON |
The first name of the authorized official. |
Authorized Official Middle Name |
ANNE |
The middle name of the authorized official. |
Authorized Official Title or Position |
PRESIDENT |
The title or position of the authorized official. |
Authorized Official Telephone Number |
7149147794 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
103TC0700X |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
Healthcare Provider Taxonomy Code 2 |
261QM0850X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
DR. |
|
Authorized Official Credential Text |
PSYD |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|