Healthcare Provider Details

I. General information

NPI: 1932489101
Provider Name (Legal Business Name): DR. EDWARD SAGISI AGNGARAYNGAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 W GRANT LINE RD
TRACY CA
95304-8427
US

IV. Provider business mailing address

1863 PERCY LN
SAN RAMON CA
94582-5923
US

V. Phone/Fax

Practice location:
  • Phone: 209-830-5342
  • Fax:
Mailing address:
  • Phone: 925-230-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: