Provider Demographics
NPI:1245750728
Name:AGUAS, LORLAINE BESARIO
Entity type:Individual
Prefix:
First Name:LORLAINE
Middle Name:BESARIO
Last Name:AGUAS
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 1:550 W CENTRAL AVE # APMT1503
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-8169
Mailing Address - Country:US
Mailing Address - Phone:209-688-7975
Mailing Address - Fax:209-688-7975
Practice Address - Street 1:2586 BUTHMANN AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2165
Practice Address - Country:US
Practice Address - Phone:209-832-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist