Individual provider · NPI-1

Elaine Grace Agustin, N.P.

Nurse Practitioner · San Bernardino, CA

NPI number1992837843

StatusActive

Last updated in NPPESJan 21, 2021

Details

NPI: 1992837843
Entity type: Individual (NPI-1)
Name: Elaine Grace Agustin
Credential: N.P.
Sex: Female
Sole proprietor: No
Enumeration date: Mar 9, 2007
Certification date: Jan 21, 2021
Last updated: Jan 21, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363L00000X	Nurse Practitioner	NP 13423	CA	Yes

Practice location

401 E Highland Ave
Suite 551
San Bernardino, CA 92404-3803

Phone 909-882-9150 · Fax 909-883-8972

Mailing address

4485 Cleveland Ave
Apt 5
San Diego, CA 92116-3985

Phone 626-484-7719

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