Provider Demographics
NPI:1669664728
Name:PAGUNTALAN, JOHN CENAROSA (NP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CENAROSA
Last Name:PAGUNTALAN
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:104 WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3837
Mailing Address - Country:US
Mailing Address - Phone:864-725-4673
Mailing Address - Fax:864-725-7424
Practice Address - Street 1:105 VINECREST CT # 510
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-8031
Practice Address - Country:US
Practice Address - Phone:864-725-4016
Practice Address - Fax:864-725-5839
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2025-01-06
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Provider Licenses
StateLicense IDTaxonomies
SC905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner