Healthcare Provider Details

I. General information

NPI: 1134536295
Provider Name (Legal Business Name): JONATHAN PASCUAL AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE 10 INTENSIVE CARDIAC CARE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

505 PARNASSUS AVE 10 INTENSIVE CARDIAC CARE
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1007
  • Fax: 415-353-1215
Mailing address:
  • Phone: 415-353-1007
  • Fax: 415-353-1215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number23663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: