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General NPI Number Information
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NPI Number | 1598984049
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Entity Type | Organization
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Legal Business Name | WINSTON C SAN AGUSTIN, M.D INC
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 N GARFIELD AVE SUITE 102
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City | MONTEREY PARK
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State | CA
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Zip | 91754-1242
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Country | US
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Telephone | 626-288-9701
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Fax | 626-288-9705
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Provider Business Mailing Address
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Address Line | 2168 S ATLANTIC BLVD PMB 309
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City | MONTEREY PARK
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State | CA
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Zip | 91754-6839
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Country | US
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Telephone | 626-458-1207
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Fax | 626-458-9981
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Authorized Official
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Title or Position | SECRETARY
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Name | ELIZABETH ILIZALITURRI
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Credential |
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Telephone | 626-458-1207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | A039652
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License Number State | CA
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