Provider Demographics
NPI:1871843797
Name:AGUSTINEZ, MARISOL SIENA
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:SIENA
Last Name:AGUSTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N 14TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6218
Mailing Address - Country:US
Mailing Address - Phone:408-445-3400
Mailing Address - Fax:408-275-1793
Practice Address - Street 1:25 N 14TH ST STE 140
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6218
Practice Address - Country:US
Practice Address - Phone:408-445-3400
Practice Address - Fax:408-275-1793
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator