Provider Demographics
NPI:1174704845
Name:AGUSTIN, JOHNNY VILLANUEVA (NP)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:VILLANUEVA
Last Name:AGUSTIN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BRIGHTSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-7032
Mailing Address - Country:US
Mailing Address - Phone:661-333-4997
Mailing Address - Fax:
Practice Address - Street 1:565 KERN ST
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2133
Practice Address - Country:US
Practice Address - Phone:661-746-4937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536811163WC1500X
CA95018599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health