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General NPI Number Information
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NPI Number | 1174329403
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Entity Type | Individual
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Provider Name | STACYRAE VIASON AGUSTO
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Gender | Female
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 8501 BRIMHALL RD BLDG 100
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2327
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Country | US
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Telephone | 661-370-0777
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Fax | 661-654-8366
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Provider Business Mailing Address
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Address Line | 8501 BRIMHALL RD BLDG 100
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2327
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Country | US
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Telephone | 661-370-0777
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Fax | 661-654-8366
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95034047
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License Number State | CA
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