Provider Demographics
NPI:1851479372
Name:AGUEY, OMAR JOSE
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:JOSE
Last Name:AGUEY
Suffix:
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 1:5717 VIA MONTELLANO
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-5904
Mailing Address - Country:US
Mailing Address - Phone:760-758-0568
Mailing Address - Fax:
Practice Address - Street 1:425 N DATE ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3413
Practice Address - Country:US
Practice Address - Phone:760-737-6951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant