Provider Demographics
NPI:1669664728
Name:PAGUNTALAN, JOHN CENAROSA (NP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CENAROSA
Last Name:PAGUNTALAN
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:157B S GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WARE SHOALS
Mailing Address - State:SC
Mailing Address - Zip Code:29692-1636
Mailing Address - Country:US
Mailing Address - Phone:864-456-3447
Mailing Address - Fax:864-725-4979
Practice Address - Street 1:157B S GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WARE SHOALS
Practice Address - State:SC
Practice Address - Zip Code:29692-1636
Practice Address - Country:US
Practice Address - Phone:864-456-3447
Practice Address - Fax:864-725-4979
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2018-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily