Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | C43004 | CA |
NPI | 1003897349 |
---|---|
Provider Name | Mark Angel Agius |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Woodland, CA 95695-5164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2005 |
Last Update Date | 25/07/2017 |