Individual
HOLLY VANDERHYDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12364 PERRIS BLVD, MORENO VALLEY, CA 92557-7423
(605) 209-6421
Mailing address
PO BOX 1593, YUCCA VALLEY, CA 92286-1593
(442) 269-1027
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95011532
CA
Other
Enumeration date
04/23/2019
Last updated
09/25/2021
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