Provider Demographics
NPI:1588058333
Name:HOLGUIN, KATHRYN
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name: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 1:101 S KRAEMER BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6110
Mailing Address - Country:US
Mailing Address - Phone:714-858-7608
Mailing Address - Fax:714-993-3501
Practice Address - Street 1:101 S KRAEMER BLVD STE 3230
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6105
Practice Address - Country:US
Practice Address - Phone:714-858-7608
Practice Address - Fax:714-993-3501
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H0000XOtherMARRIAGE AND FAMILY THERAPIST