Provider Demographics
NPI:1558432021
Name:AGRESTI, ERNESTINA T (DO)
Entity Type:Individual
Prefix:DR
First Name:ERNESTINA
Middle Name:T
Last Name:AGRESTI
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:8735 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5920
Mailing Address - Country:US
Mailing Address - Phone:916-786-5908
Mailing Address - Fax:916-786-8958
Practice Address - Street 1:8735 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5920
Practice Address - Country:US
Practice Address - Phone:916-786-5908
Practice Address - Fax:916-786-8958
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-09-14
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Provider Licenses
StateLicense IDTaxonomies
CA20A4225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080035504OtherMEDICARE RAILROAD