Provider Demographics
NPI:1295882603
Name:HOLT, SCOTT EDWARD
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:EDWARD
Last Name:HOLT
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 1:1260 A ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2961
Mailing Address - Country:US
Mailing Address - Phone:510-538-8884
Mailing Address - Fax:510-538-5144
Practice Address - Street 1:1260 A ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2961
Practice Address - Country:US
Practice Address - Phone:510-538-8884
Practice Address - Fax:510-538-5144
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1679237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA0016790Medicaid