Provider Demographics
NPI:1114225760
Name:HOLLY BETH GOGUEN
Entity Type:Organization
Organization Name:HOLLY BETH GOGUEN
Other - Org Name:HOLLY B GOGUEN LAC ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:GOGUEN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:415-533-7023
Mailing Address - Street 1:439 1/2 N OGDEN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-1748
Mailing Address - Country:US
Mailing Address - Phone:323-937-4099
Mailing Address - Fax:
Practice Address - Street 1:915 S CATALINA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4795
Practice Address - Country:US
Practice Address - Phone:310-543-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11826171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty