Healthcare Provider Details

I. General information

NPI: 1932507704
Provider Name (Legal Business Name): ROBERT VINCENT AUGAT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CALIFORNIA ST
STOCKTON CA
95204-6019
US

IV. Provider business mailing address

4030 MARITIME CT
STOCKTON CA
95219-2035
US

V. Phone/Fax

Practice location:
  • Phone: 310-890-0169
  • Fax:
Mailing address:
  • Phone: 310-890-0169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: