Provider Demographics
NPI:1043269434
Name:JUGUILON, AUGUSTO C (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:C
Last Name:JUGUILON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-356-1256
Practice Address - Street 1:1711 27TH ST # 103A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2654
Practice Address - Country:US
Practice Address - Phone:740-356-6740
Practice Address - Fax:740-356-1274
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350370662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0256995Medicaid
OHB97534Medicare UPIN
OH0256995Medicaid