Healthcare Provider Details

I. General information

NPI: 1447165089
Provider Name (Legal Business Name): JESSICA HOLGUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ODELL LANE
AZUSA CA
91702
US

IV. Provider business mailing address

701 ODELL LANE
AZUSA CA
91702
US

V. Phone/Fax

Practice location:
  • Phone: 626-815-5386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95224503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: