Provider Demographics
NPI:1316217987
Name:MANOSCA, AGNES CASTILLO (NP, RN)
Entity Type:Individual
Prefix:MS
First Name:AGNES
Middle Name:CASTILLO
Last Name:MANOSCA
Suffix:
Gender:F
Credentials:NP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:319 HALYARD LN
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3920
Mailing Address - Country:US
Mailing Address - Phone:415-706-0944
Mailing Address - Fax:
Practice Address - Street 1:5671 SANTA TERESA BLVD
Practice Address - Street 2:105
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-6512
Practice Address - Country:US
Practice Address - Phone:408-284-2280
Practice Address - Fax:408-281-2857
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA640686163W00000X
CA20976164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse