Individual
ELAINE GRACE AGUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
401 E HIGHLAND AVE, SUITE 551, SAN BERNARDINO, CA 92404-3803
(909) 882-9150
(909) 883-8972
Mailing address
4485 CLEVELAND AVE, APT 5, SAN DIEGO, CA 92116-3985
(626) 484-7719
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP 13423
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP 13423
NURSE PRACTITIONER
CA
01
—
RN 549365
REGISTERED NURSE
CA
Enumeration date
03/09/2007
Last updated
01/21/2021
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