Provider Demographics
NPI:1033748546
Name:AGUSTIN, JESSICA STEPHANIE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:STEPHANIE
Last Name:AGUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 W MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1729
Mailing Address - Country:US
Mailing Address - Phone:760-745-0281
Mailing Address - Fax:760-745-0778
Practice Address - Street 1:337 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1729
Practice Address - Country:US
Practice Address - Phone:760-745-0281
Practice Address - Fax:760-745-0778
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator