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General NPI Number Information
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NPI Number | 1023973153
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Entity Type | Individual
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Provider Name | MR. PABLO JULIAN AGRIO SR.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2025
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Last Update Date | 12/20/2025
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Provider Practice Location Address
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Address Line | 450 E SAN JACINTO AVE STE 3
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City | PERRIS
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State | CA
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Zip | 92571-2833
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Country | US
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Telephone | 951-443-2186
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Fax |
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Provider Business Mailing Address
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Address Line | 26120 FAIRLANE DR
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City | MENIFEE
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State | CA
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Zip | 92586-1923
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Country | US
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Telephone | 951-443-2186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | MPSS-BDIMLW
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License Number State | CA
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