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Individual

MR. EVAGRIO PAGKALIWANGAN BENCITO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
1000 W CARSON ST, CARSON, CA 90810-1408
(310) 222-3528
Mailing address
3564 BRENTON AVE APT E, LYNWOOD, CA 90262-2063
(310) 639-5282

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
565369
CA
364SA2100X
Acute Care Clinical Nurse Specialist
Primary
17801
CA

Other

Enumeration date
06/13/2008
Last updated
06/13/2008
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