Provider Demographics
NPI:1316703267
Name:HOLGUIN HOLGUIN, MINERVA
Entity type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:HOLGUIN HOLGUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 JOHNSON CT
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1737
Mailing Address - Country:US
Mailing Address - Phone:202-805-8948
Mailing Address - Fax:
Practice Address - Street 1:3210 JOHNSON CT
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-1737
Practice Address - Country:US
Practice Address - Phone:202-805-8948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide