Healthcare Provider Details

I. General information

NPI: 1295167443
Provider Name (Legal Business Name): JAIME LACARA AGLUGUB NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 S EL CAMINO REAL SUITE 104
OCEANSIDE CA
92054-6229
US

IV. Provider business mailing address

2171 S EL CAMINO REAL SUITE 104
OCEANSIDE CA
92054-6229
US

V. Phone/Fax

Practice location:
  • Phone: 760-754-5663
  • Fax:
Mailing address:
  • Phone: 760-754-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: