Provider Demographics
NPI:1528249596
Name:HOLLINGSEAD, JOHN D (CPO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:HOLLINGSEAD
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8260 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3954
Mailing Address - Country:US
Mailing Address - Phone:805-466-1296
Mailing Address - Fax:805-466-9504
Practice Address - Street 1:310 S HALCYON RD
Practice Address - Street 2:STE. 104
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3872
Practice Address - Country:US
Practice Address - Phone:805-481-9666
Practice Address - Fax:805-466-9504
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXB0017490Medicaid
CAXB0017490Medicaid