Provider Demographics
NPI:1609151901
Name:AGUSTIN, GREGORIO SAN VALENTIN JR (RN)
Entity Type:Individual
Prefix:MR
First Name:GREGORIO
Middle Name:SAN VALENTIN
Last Name:AGUSTIN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11081 ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3366
Mailing Address - Country:US
Mailing Address - Phone:714-310-1568
Mailing Address - Fax:
Practice Address - Street 1:11081 ORCHARD PL
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3366
Practice Address - Country:US
Practice Address - Phone:714-310-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA759832163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA759832OtherBOARD OF REGISTERED NURSING