Provider Demographics
NPI:1205869807
Name:JAUREGUI, NICHOLAS JOHN (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN
Last Name:JAUREGUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:80 W SIERRA MADRE BLVD
Mailing Address - Street 2:SUITE 352
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2434
Mailing Address - Country:US
Mailing Address - Phone:877-830-7328
Mailing Address - Fax:877-830-7469
Practice Address - Street 1:80 W SIERRA MADRE BLVD
Practice Address - Street 2:SUITE 352
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2434
Practice Address - Country:US
Practice Address - Phone:877-830-7328
Practice Address - Fax:877-830-7469
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62786207Q00000X, 207RH0002X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75174Medicare UPIN