Provider Demographics
NPI:1023304441
Name:HOLLOWAY, LARRY BERNARD (PROBATION OFFICER 2)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:BERNARD
Last Name:HOLLOWAY
Suffix:
Gender:M
Credentials:PROBATION OFFICER 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12310 LOWER AZUSA RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5872
Mailing Address - Country:US
Mailing Address - Phone:626-579-8506
Mailing Address - Fax:626-433-1029
Practice Address - Street 1:12310 LOWER AZUSA RD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5872
Practice Address - Country:US
Practice Address - Phone:626-579-8593
Practice Address - Fax:626-433-1029
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA876543100OtherPROBATION
CA171M00000XOtherPROBATION