Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 802572 | ZZ |
NPI | 1003280207 |
---|---|
Provider Name | Agustin Jauregui Romero |
First Address | Bonita, CA 91902-1421 |
Second Address | Tijuana, BAJA CALIFORNIA 22000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2015 |
Last Update Date | 25/11/2015 |