Provider Demographics
NPI:1558506865
Name:ROUGEAU, SEAN ERIC (NP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ERIC
Last Name:ROUGEAU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 ROSEMEAD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2830
Mailing Address - Country:US
Mailing Address - Phone:626-227-7014
Mailing Address - Fax:
Practice Address - Street 1:3208 ROSEMEAD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731
Practice Address - Country:US
Practice Address - Phone:626-227-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA523801163WA2000X
CA95003703363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator