Provider Demographics
NPI:1700244951
Name:AGUSTIN, MARIA CRISTINA DE JESUS
Entity type:Individual
Prefix:MRS
First Name:MARIA CRISTINA
Middle Name:DE JESUS
Last Name:AGUSTIN
Suffix:
Gender:F
Credentials:
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:661-372-2964
Mailing Address - Fax:661-829-6141
Practice Address - Street 1:403 BRIGHTSTONE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-7032
Practice Address - Country:US
Practice Address - Phone:661-372-2964
Practice Address - Fax:661-829-6141
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant