Basic Information
| Provider Information | |||||||||
| NPI: | 1346472743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLDEN | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | LOMA LINDA UNIVERSITY MEDICAL CTR | ||||||||
| Address2: | 11234 ANDERSON STREET, LOMA LINDA | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923500001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095584000 | ||||||||
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| Practice Location | |||||||||
| Address1: | LOMA LINDA UNIVERSITY MEDICAL CTR | ||||||||
| Address2: | 11234 ANDERSON STREET, LOMA LINDA | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923500001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095584000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2009 | ||||||||
| LastUpdateDate: | 12/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1011024 | CA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.