Provider Demographics
NPI:1710420377
Name:HOLGUIN, SHAWNA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LYNN
Last Name:HOLGUIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:LYNN
Other - Last Name:SALEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1212 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1552
Mailing Address - Country:US
Mailing Address - Phone:209-468-8842
Mailing Address - Fax:
Practice Address - Street 1:1212 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1552
Practice Address - Country:US
Practice Address - Phone:209-468-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40252167G00000X
CA1606131163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician