Provider Demographics
NPI:1285963165
Name:REESE, HOLLY (MS LAC)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:
Last Name:REESE
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CHALDA WAY
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-2350
Mailing Address - Country:US
Mailing Address - Phone:510-484-4253
Mailing Address - Fax:
Practice Address - Street 1:2719 ENCINAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4784
Practice Address - Country:US
Practice Address - Phone:510-484-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-6407171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist