Healthcare Provider Details

I. General information

NPI: 1184205049
Provider Name (Legal Business Name): PAULO AGURA BUIGASCO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 09/29/2026
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 OLD DEL MONTE ST
STOCKTON CA
95206-5822
US

IV. Provider business mailing address

2613 N 110TH DR
AVONDALE AZ
85392-5892
US

V. Phone/Fax

Practice location:
  • Phone: 480-479-2790
  • Fax:
Mailing address:
  • Phone: 480-479-2790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number606060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: