Healthcare Provider Details

I. General information

NPI: 1982905774
Provider Name (Legal Business Name): MS. ROSITA PILAR HOLGUIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 JEFFERSON ST
BROOKLYN NY
11206-6101
US

IV. Provider business mailing address

142 JEFFERSON ST APT 2
BROOKLYN NY
11206-6101
US

V. Phone/Fax

Practice location:
  • Phone: 347-417-1825
  • Fax:
Mailing address:
  • Phone: 347-417-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1200757
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: