Provider Demographics
NPI:1336195890
Name:AGUSTINES, DAVIN ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:DAVIN
Middle Name:ANTHONY
Last Name:AGUSTINES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14445 OLIVE VIEW DR
Mailing Address - Street 2:ROOM 6D129
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1437
Mailing Address - Country:US
Mailing Address - Phone:818-364-4304
Mailing Address - Fax:818-332-7072
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:ROOM 6D129
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:818-364-4304
Practice Address - Fax:818-332-7072
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A81792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35928Medicare UPIN
020A81790Medicare ID - Type Unspecified