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General NPI Number Information
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NPI Number | 1992945018
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Entity Type | Organization
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Legal Business Name | AGUSTIN SUPPLIES & SERVICES INC
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Dates
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Enumeration Date | 03/02/2009
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 13281 HARBOR BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1719
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Country | US
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Telephone | 714-281-5932
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Fax | 714-281-5932
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Provider Business Mailing Address
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Address Line | 13281 HARBOR BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1719
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Country | US
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Telephone | 714-281-5932
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Fax | 714-281-5932
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MISS GIZELLE ES. GONZALES
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Credential | RN
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Telephone | 714-281-5932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | BUS2009-00739
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License Number State | CA
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