Healthcare Provider Details

I. General information

NPI: 1134033483
Provider Name (Legal Business Name): LOUIS HOLGUIN III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 E HIGHLAND AVE
SAN BERNARDINO CA
92404-4611
US

IV. Provider business mailing address

400 N PEPPER AVE
COLTON CA
92324-1801
US

V. Phone/Fax

Practice location:
  • Phone: 909-386-9780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: