Provider Demographics
NPI:1750081451
Name:AGLUBAT, ANIKA CYRA NICOLAS
Entity type:Individual
Prefix:
First Name:ANIKA CYRA
Middle Name:NICOLAS
Last Name:AGLUBAT
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 1:8484 TAPIES CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-9582
Mailing Address - Country:US
Mailing Address - Phone:916-996-9390
Mailing Address - Fax:
Practice Address - Street 1:8484 TAPIES CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9582
Practice Address - Country:US
Practice Address - Phone:916-996-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist