Provider Demographics
NPI:1902497530
Name:HOLGUIN, STAN
Entity Type:Individual
Prefix:
First Name:STAN
Middle Name:
Last Name:HOLGUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 SOHI LN APT 2
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7360
Mailing Address - Country:US
Mailing Address - Phone:907-252-0780
Mailing Address - Fax:
Practice Address - Street 1:508 UPLAND ST
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-8026
Practice Address - Country:US
Practice Address - Phone:907-252-0780
Practice Address - Fax:888-491-3243
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist