Provider Demographics
NPI:1437676160
Name:AGUSTIN, ALFREDO JAVIER III
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:JAVIER
Last Name:AGUSTIN
Suffix:III
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 1:3950 BRISTLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-6241
Mailing Address - Country:US
Mailing Address - Phone:916-428-0743
Mailing Address - Fax:
Practice Address - Street 1:3950 BRISTLEWOOD WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-6241
Practice Address - Country:US
Practice Address - Phone:916-428-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225095164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse