MEDICARE: ALEJANDRO PAUL HOLGUIN MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical	82320	CA

General Provider Information

NPI Number	:	1720239304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO PAUL HOLGUIN MSW

Provider Business Mailing Address
First Line	:	400 N PEPPER AVE
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324-1801
Country	:	US
Telephone Number	:	909-580-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N PEPPER
Second Line	:
City	:	COLTON
State	:	CA
Zip	:	92324
Country	:	US
Telephone Number	:	909-580-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2008
Last Update Date	:	04/19/2018

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