Basic Information
| Provider Information | |||||||||
| NPI: | 1821076092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOBART | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2040 W CHARLESTON BLVD | ||||||||
| Address2: | 202-A | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026712355 | ||||||||
| FaxNumber: | 7023825388 | ||||||||
| Practice Location | |||||||||
| Address1: | 1707 W. CHARLESTON BLVD- DBA NEVADA GENETICS LABORATORY | ||||||||
| Address2: | 110-B | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026715055 | ||||||||
| FaxNumber: | 7026710193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207SC0300X | 16016 DIR-0 | NV | X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Cytogenetic | 207SG0205X | 16016 DIR-0 | NV | X | Allopathic & Osteopathic Physicians | Medical Genetics | Ph.D. Medical Genetics |
ID Information
| ID | Type | State | Issuer | Description | 16016-DIR-0 | 01 | NV | STAT LICENSE | OTHER |