Provider Demographics
NPI:1841473485
Name:NICHOLAS JAUREGUI MD INC
Entity type:Organization
Organization Name:NICHOLAS JAUREGUI MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JAUREGUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-830-7328
Mailing Address - Street 1:80 W SIERRA MADRE BLVD # 352
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2434
Mailing Address - Country:US
Mailing Address - Phone:877-830-7328
Mailing Address - Fax:877-830-7469
Practice Address - Street 1:80 W SIERRA MADRE BLVD
Practice Address - Street 2:SUITE 352
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2434
Practice Address - Country:US
Practice Address - Phone:877-830-7328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00603516OtherRAILROAD MEDICARE PIN
CA00A627861Medicaid
CADN0861OtherRAILROAD MEDICARE GROUP ID
CAW21495Medicare PIN
CAWA62786DMedicare PIN