Individual
AUGIE N. PROVENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 B ST BLDG A-C, LIVINGSTON, CA 95334-9593
(209) 850-3500
Mailing address
600 B ST BLDG A-C, LIVINGSTON, CA 95334-9593
(209) 850-3500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36333
AZ
207Q00000X
Family Medicine Physician
3673
AK
207Q00000X
Family Medicine Physician
Primary
A48099
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A480990
—
CA
05
—
539497
—
AZ
Enumeration date
02/02/2007
Last updated
03/23/2022
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