Provider Demographics
NPI:1558189746
Name:HOLLOMAN, PEYTON
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:
Last Name:HOLLOMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28381 RANCHO DE LINDA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7401
Mailing Address - Country:US
Mailing Address - Phone:626-664-7582
Mailing Address - Fax:
Practice Address - Street 1:28381 RANCHO DE LINDA
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7401
Practice Address - Country:US
Practice Address - Phone:626-664-7582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician