Provider Demographics
NPI:1952817363
Name:PANGELINAN, JOSHUA JORDAN AGUIGUI
Entity Type:Individual
Prefix:MR
First Name:JOSHUA JORDAN
Middle Name:AGUIGUI
Last Name:PANGELINAN
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 1:32577 DAHLIA LN
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7997
Mailing Address - Country:US
Mailing Address - Phone:951-446-9959
Mailing Address - Fax:
Practice Address - Street 1:32577 DAHLIA LN
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7997
Practice Address - Country:US
Practice Address - Phone:951-446-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician