Provider Demographics
NPI:1154632701
Name:HOLGUIN, LEONARDO FABIO (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:FABIO
Last Name:HOLGUIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:157 BROAD ST
Mailing Address - Street 2:SUITE 317
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2028
Mailing Address - Country:US
Mailing Address - Phone:732-530-2960
Mailing Address - Fax:732-530-7446
Practice Address - Street 1:157 BROAD ST
Practice Address - Street 2:SUITE 317
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2028
Practice Address - Country:US
Practice Address - Phone:732-530-2960
Practice Address - Fax:732-530-7446
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08777200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine