Healthcare Provider Details

I. General information

NPI: 1699338749
Provider Name (Legal Business Name): PETER HOLGUIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC 09-5030 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131
US

IV. Provider business mailing address

MSC 09-5030 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2223
  • Fax: 505-272-4639
Mailing address:
  • Phone: 505-272-2223
  • Fax: 505-272-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2023-1152
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD2023-1152
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: