Provider Demographics
NPI:1457420010
Name:AUGUSTINE, AYLEEN ANNETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:AYLEEN
Middle Name:ANNETTE
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 KOLL CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4616
Mailing Address - Country:US
Mailing Address - Phone:408-313-7641
Mailing Address - Fax:
Practice Address - Street 1:1460 KOLL CIR
Practice Address - Street 2:SUITE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4616
Practice Address - Country:US
Practice Address - Phone:408-313-7641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA70-06-079-205-000Medicare UPIN