MEDICARE: BLESSY SABU AGAC-NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	NP95009183	CA
2	363LC0200X	Critical Care Medicine Nurse Practitioner	NP95009183	CA

General Provider Information

NPI Number	:	1841774817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLESSY SABU AGAC-NP

Provider Business Mailing Address
First Line	:	14539 ALDER DR
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	92880-9616
Country	:	US
Telephone Number	:	714-329-2868
Fax Number	:

Provider Business Practice Location Address
First Line	:	11201 BENTON ST
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92357-3312
Country	:	US
Telephone Number	:	909-825-7084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	03/22/2025

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