Healthcare Provider Details

I. General information

NPI: 1386405785
Provider Name (Legal Business Name): MARIBEL HOLGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CAMINO DEL REMEDIO
SANTA BARBARA CA
93110-1332
US

IV. Provider business mailing address

332 AVION PARK DR SUITE 300
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-5244
  • Fax:
Mailing address:
  • Phone: 813-280-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number528132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: