Provider Demographics
NPI:1902348212
Name:HOLGUIN, YANIRA (RDN)
Entity Type:Individual
Prefix:MRS
First Name:YANIRA
Middle Name:
Last Name:HOLGUIN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N WACKER DR
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1743
Mailing Address - Country:US
Mailing Address - Phone:571-342-8915
Mailing Address - Fax:
Practice Address - Street 1:3167 CONSTELLATION DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2363
Practice Address - Country:US
Practice Address - Phone:813-361-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered