MEDICARE: MR. JAIME LACARA AGLUGUB NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	22963	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22963	OTHER	CA	BD OF REGISTERD NURSE

General Provider Information

NPI Number	:	1295167443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAIME LACARA AGLUGUB NP

Provider Business Mailing Address
First Line	:	2171 S EL CAMINO REAL
Second Line	:	SUITE 104
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6229
Country	:	US
Telephone Number	:	760-754-5663
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 S EL CAMINO REAL
Second Line	:	SUITE 104
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6229
Country	:	US
Telephone Number	:	760-754-5663
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	07/30/2013

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