Healthcare Provider Details

I. General information

NPI: 1528808748
Provider Name (Legal Business Name): AGUSTIN GONZALO MIGUEL GARCIA MS RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 4093
VENTURA CA
93007-0093
US

IV. Provider business mailing address

PO BOX 4093
VENTURA CA
93007-0093
US

V. Phone/Fax

Practice location:
  • Phone: 808-639-4057
  • Fax:
Mailing address:
  • Phone: 808-639-4057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number86095918
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86095918
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number86095918
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number86095918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: