Provider Demographics
NPI:1225327448
Name:OLGUIN, DINA RENEE (CAC II)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:RENEE
Last Name:OLGUIN
Suffix:
Gender:F
Credentials:CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CARBON
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-3664
Mailing Address - Country:US
Mailing Address - Phone:719-846-4482
Mailing Address - Fax:
Practice Address - Street 1:1004 CARBON
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-3664
Practice Address - Country:US
Practice Address - Phone:719-846-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACB6686171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator