Provider Demographics
NPI:1366922262
Name:HOLGUIN, MIGUEL SANTIAGO (BCBA)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:SANTIAGO
Last Name:HOLGUIN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 SUNFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1215
Mailing Address - Country:US
Mailing Address - Phone:971-404-8577
Mailing Address - Fax:
Practice Address - Street 1:5834 ADENMOOR AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1002
Practice Address - Country:US
Practice Address - Phone:310-310-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-30780103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst