Provider Demographics
NPI:1750610085
Name:HOLLEY, RONALD BRIAN (CSA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:BRIAN
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24410 CHIPWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355
Mailing Address - Country:US
Mailing Address - Phone:832-928-6380
Mailing Address - Fax:
Practice Address - Street 1:21212 NORTHWEST FWY
Practice Address - Street 2:605
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5884
Practice Address - Country:US
Practice Address - Phone:281-955-7577
Practice Address - Fax:281-955-5875
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3484246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3484OtherNATIONAL SURGICAL ASSISTANT ASSOCIATION