Provider Demographics
NPI:1184205049
Name:BUIGASCO, PAULO AGURA (RN)
Entity Type:Individual
Prefix:
First Name:PAULO
Middle Name:AGURA
Last Name:BUIGASCO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 N 110TH DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5892
Mailing Address - Country:US
Mailing Address - Phone:480-479-2790
Mailing Address - Fax:
Practice Address - Street 1:2390 OLD DEL MONTE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-5822
Practice Address - Country:US
Practice Address - Phone:480-479-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606060163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Single Specialty