Healthcare Provider Details

I. General information

NPI: 1023973153
Provider Name (Legal Business Name): MR. PABLO JULIAN AGRIO SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SAN JACINTO AVE STE 3
PERRIS CA
92571-2833
US

IV. Provider business mailing address

26120 FAIRLANE DR
MENIFEE CA
92586-1923
US

V. Phone/Fax

Practice location:
  • Phone: 951-443-2186
  • Fax:
Mailing address:
  • Phone: 951-443-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberMPSS-BDIMLW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: