Healthcare Provider Details

I. General information

NPI: 1922963966
Provider Name (Legal Business Name): JAIME MANUEL AGUSTIN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 UNIVERSE CIR
OXNARD CA
93033-2441
US

IV. Provider business mailing address

217 E 6TH ST APT 311
OXNARD CA
93030-7929
US

V. Phone/Fax

Practice location:
  • Phone: 805-725-0640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: