Provider Demographics
NPI:1952319998
Name:HOLGUIN, GABRIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:HOLGUIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25930 LAUREL PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2472
Mailing Address - Country:US
Mailing Address - Phone:210-885-5320
Mailing Address - Fax:830-438-5040
Practice Address - Street 1:17890 BLANCO RD STE 303
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1031
Practice Address - Country:US
Practice Address - Phone:210-393-6230
Practice Address - Fax:830-438-5040
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0062MXOtherBLUE CROSS BLUE SHIELD
TX612036Medicare ID - Type Unspecified