Healthcare Provider Details

I. General information

NPI: 1942258116
Provider Name (Legal Business Name): AGUSTIN A GARCIA CABALLERO MONGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52579 HIGHWAY 51 S
INDEPENDENCE LA
70443-2231
US

IV. Provider business mailing address

PO BOX 919313
DALLAS TX
75391-9313
US

V. Phone/Fax

Practice location:
  • Phone: 985-878-9421
  • Fax: 985-878-1306
Mailing address:
  • Phone: 855-707-1542
  • Fax: 337-237-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA52720
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD.207740
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: