Healthcare Provider Details

I. General information

NPI: 1255210449
Provider Name (Legal Business Name): MICHAEL SAN AGUSTIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

9192 ANSON RIVER CIR
FOUNTAIN VALLEY CA
92708-4428
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-2326
  • Fax:
Mailing address:
  • Phone: 949-275-8216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number59811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: