Healthcare Provider Details

I. General information

NPI: 1760099246
Provider Name (Legal Business Name): AGUSTIN MEZA NUNEZ B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SUN ST
SALINAS CA
93901-3714
US

IV. Provider business mailing address

8 SUN ST
SALINAS CA
93901-3714
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-5145
  • Fax:
Mailing address:
  • Phone: 831-753-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1398100720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: