MEDICARE: MR. AUGUSTINE JOHN WAGASKY

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	172V00000X	Community Health Worker	5182	NV

General Provider Information

NPI Number	:	1679440481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AUGUSTINE JOHN WAGASKY

Provider Business Mailing Address
First Line	:	7132 ACORN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-4716
Country	:	US
Telephone Number	:	702-384-2238
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 S JONES BLVD STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5605
Country	:	US
Telephone Number	:	702-384-2238
Fax Number	:

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

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	10/17/2025

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