Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Holly K Fanning, PA

Individual provider Medical Physician Assistant · NPI 1104387448

Holly K Fanning, PA is a Physician Assistant in LA Jolla, California. Qualified in 2018, 8 years ago. Practices with Southeastern Intensivist Services PC, a 237-clinician group and accepts Medicare assignment. Licensed in California and New York.

Years since qualifying
8
Licensed in
CA, NY
In the registry since
2019
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

10666 N Torrey Pines Rd
LA Jolla, CA 92037-1027
Phone: (858) 554-7909
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA60834 (CA)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 023260 (NY)

Record details

NPI number1104387448
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMarch 28, 2019
Last updated in NPPESJanuary 4, 2023
Certification dateJanuary 4, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Southeastern Intensivist Services Pc — 237 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Colleagues at Southeastern Intensivist Services PC

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 237 clinicians in the practice; 12 are shown here.

Other providers in LA Jolla