Provider Demographics
NPI:1326218116
Name:GOGUEN, HOLLY BETH (LAC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:BETH
Last Name:GOGUEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:415-533-7023
Mailing Address - Fax:323-857-1220
Practice Address - Street 1:915 S CATALINA AVE STE B
Practice Address - Street 2:
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:323-857-1220
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11826171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist