Healthcare Provider Details

I. General information

NPI: 1386482537
Provider Name (Legal Business Name): AGNES N LOSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2761 SATURN ST STE J
BREA CA
92821-6707
US

IV. Provider business mailing address

2043 SAN FRANCISCO AVE
LONG BEACH CA
90806-4146
US

V. Phone/Fax

Practice location:
  • Phone: 562-889-4256
  • Fax: 888-891-6599
Mailing address:
  • Phone: 562-889-6599
  • Fax: 888-891-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24-368842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: