Provider Demographics
NPI:1114387479
Name:HOLGUIN, FREDDY
Entity type:Individual
Prefix:
First Name:FREDDY
Middle Name:
Last Name:HOLGUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 KIMBALL AVE
Mailing Address - Street 2:APT 1B
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1569
Mailing Address - Country:US
Mailing Address - Phone:850-420-5715
Mailing Address - Fax:
Practice Address - Street 1:780 KIMBALL AVE
Practice Address - Street 2:APT 1B
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1569
Practice Address - Country:US
Practice Address - Phone:850-420-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTC 47244246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist