Provider Demographics
NPI:1962252767
Name:EDDY, HOLLY MELINDA (COTA)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:MELINDA
Last Name:EDDY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 E CAMINO ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-9315
Mailing Address - Country:US
Mailing Address - Phone:858-822-8087
Mailing Address - Fax:
Practice Address - Street 1:4043 E CAMINO ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-9315
Practice Address - Country:US
Practice Address - Phone:858-822-8087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-0472292083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine