Provider Demographics
NPI:1407908056
Name:AGUNOD, CARLITO REDULLA (LVN)
Entity Type:Individual
Prefix:MR
First Name:CARLITO
Middle Name:REDULLA
Last Name:AGUNOD
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 N KATY AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6868
Mailing Address - Country:US
Mailing Address - Phone:559-276-8102
Mailing Address - Fax:
Practice Address - Street 1:5070 E BELGRAVIA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-1239
Practice Address - Country:US
Practice Address - Phone:559-255-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 211097164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEPS013350Medicaid
CARVN001820Medicaid