Basic Information
| Provider Information | |||||||||
| NPI: | 1730717562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOLGADO | ||||||||
| FirstName: | KRISTOPHER | ||||||||
| MiddleName: | MAUN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 S FREMONT AVE UNIT 27 | ||||||||
| Address2: | |||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918038849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136074400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 S FREMONT AVE UNIT 27 | ||||||||
| Address2: | |||||||||
| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918038849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136074400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2020 | ||||||||
| LastUpdateDate: | 03/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.