Active NPI
Mallory Holguin
- Behavior Technician
- Port Saint Lucie, FL
National Provider Identifier
1205526076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-23-273389
- Practice address
- 1801 SE Hillmoor Dr Ste B-101
Port Saint Lucie, FL 34952-7545 - Phone
- (772) 219-7575
- NPI assigned
- May 15, 2023
- Last updated
- May 15, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-23-273389 | FL | Primary |
Addresses
Primary practice location
1801 SE Hillmoor Dr Ste B-101
Port Saint Lucie, FL 34952-7545
Mailing address
1270 SW Aragon Ave
Port Saint Lucie, FL 34953-4823
Phone (772) 877-9755
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-23-273389 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684108800000",
"number": "1205526076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1270 SW ARAGON AVE",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349534823",
"telephone_number": "772-877-9755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 SE HILLMOOR DR STE B-101",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349527545",
"telephone_number": "772-219-7575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOLGUIN",
"first_name": "MALLORY",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-15",
"last_updated": "2023-05-15",
"certification_date": "2023-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-23-273389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Saint Lucie, FL
- Trina Lynn Hodge, MS
- Byron Ian Hoffman, DC
- Chelsea Hoffman, MS, CCC-SLP
- Ross C. Hoffman, L.M.T.
- Kimberly Ann Hogan, M.S. MFC
- Holiday CVS LLC (CVS Pharmacy #05157)
- Holiday CVS LLC (CVS Pharmacy #04041)
- Holistic Health on the Go, Inc. (Rachelle Tetreault)
- Sean Mitchell Josiah Holman
- Home of Serenity LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.