Active NPI
Shelley Holt
- Prevention Professional
- San Bernardino, CA
National Provider Identifier
1477090041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 0000000
- Practice address
- 17573 Chervil LN
San Bernardino, CA 92407-9068 - Phone
- (909) 544-6482
- NPI assigned
- Jan 20, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 0000000 | CA | Primary |
Addresses
Primary practice location
17573 Chervil LN
San Bernardino, CA 92407-9068
Mailing address
17573 Chervil LN
San Bernardino, CA 92407-9068
Phone (909) 544-6482
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000000 | CA | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484870400000",
"number": "1477090041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17573 CHERVIL LN",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924079068",
"telephone_number": "909-544-6482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17573 CHERVIL LN",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924079068",
"telephone_number": "909-544-6482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLT",
"first_name": "SHELLEY",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-20",
"last_updated": "2017-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "CA",
"license": "0000000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.