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General NPI Number Information
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NPI Number | 1669664728
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Entity Type | Individual
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Provider Name | JOHN CENAROSA PAGUNTALAN NP
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Gender | Male
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 105 VINECREST CT # 510
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City | GREENWOOD
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State | SC
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Zip | 29646-8031
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Country | US
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Telephone | 864-725-4016
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Fax | 864-725-5839
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Provider Business Mailing Address
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Address Line | 104 WELLS AVE
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City | GREENWOOD
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State | SC
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Zip | 29646-3837
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Country | US
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Telephone | 864-725-4673
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Fax | 864-725-7424
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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 | 905
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License Number State | SC
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