Healthcare Provider Details

I. General information

NPI: 1154184927
Provider Name (Legal Business Name): VALERIE HOLGUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 17TH AVE S
FARGO ND
58103-3840
US

IV. Provider business mailing address

8073 E APACHE PLUMB DR
GOLD CANYON AZ
85118-2014
US

V. Phone/Fax

Practice location:
  • Phone: 602-909-7763
  • Fax:
Mailing address:
  • Phone: 602-909-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number990-24
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: