Provider Demographics
NPI:1124583174
Name:NAGUIAT, RANDY ESTEBAN
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:ESTEBAN
Last Name:NAGUIAT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13152 ROBERTA PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2144
Mailing Address - Country:US
Mailing Address - Phone:714-951-4535
Mailing Address - Fax:
Practice Address - Street 1:13152 ROBERTA PL
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2144
Practice Address - Country:US
Practice Address - Phone:714-951-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA792883163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse