Provider Demographics
NPI:1194214569
Name:HOLGUIN, FLORINA T
Entity Type:Individual
Prefix:
First Name:FLORINA
Middle Name:T
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 1:5417 PACER VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-4304
Mailing Address - Country:US
Mailing Address - Phone:661-477-3422
Mailing Address - Fax:661-664-8836
Practice Address - Street 1:5417 PACER VALLEY CT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4304
Practice Address - Country:US
Practice Address - Phone:661-663-7468
Practice Address - Fax:661-664-8836
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN685270164X00000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87-0760436Medicaid