Provider Demographics
NPI:1912890799
Name:OLGUIN, GRACE VICTORIA
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:VICTORIA
Last Name:OLGUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 CORRINNE PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4011
Mailing Address - Country:US
Mailing Address - Phone:925-786-8774
Mailing Address - Fax:
Practice Address - Street 1:151 8TH ST S RM 115
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4423
Practice Address - Country:US
Practice Address - Phone:320-308-3830
Practice Address - Fax:320-308-3831
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician