Provider Demographics
NPI:1649000316
Name:AGUSTIN, MARIA ALEXIS (RN)
Entity type:Individual
Prefix:MRS
First Name:MARIA ALEXIS
Middle Name:
Last Name:AGUSTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1514
Mailing Address - Country:US
Mailing Address - Phone:916-703-2716
Mailing Address - Fax:
Practice Address - Street 1:2279 45TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1514
Practice Address - Country:US
Practice Address - Phone:916-703-2716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95269612163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology