Provider Demographics
NPI:1275833170
Name:AGOJO, JULIE AUXENIA BALLESTEROS (RN)
Entity Type:Individual
Prefix:
First Name:JULIE AUXENIA
Middle Name:BALLESTEROS
Last Name:AGOJO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19200 LYDLE CREEK PL
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4302
Mailing Address - Country:US
Mailing Address - Phone:213-738-3787
Mailing Address - Fax:213-351-2491
Practice Address - Street 1:19200 LYDLE CREEK PL
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4302
Practice Address - Country:US
Practice Address - Phone:213-738-3787
Practice Address - Fax:213-351-2491
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse