Elleen Myre Zoleta Agustin, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105628 Issued in CA

Practice address

103 Las Tunas Dr
Arcadia, CA 91007-8550

Phone

(626) 445-2903

NPI assigned

Oct 7, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1104423698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7170 N MUSCATEL AVE",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917751232",
            "telephone_number": "808-321-5768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 LAS TUNAS DR",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910078550",
            "telephone_number": "626-445-2903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGUSTIN",
        "first_name": "ELLEEN MYRE",
        "middle_name": "ZOLETA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-07",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anjali Agrawal, P.A.
• Fatima Opina Agregado, L.C.S.W.
• Katherine Agron, NP
• Angela S Aguilar
• Genesis Aguirre
• Ayla Ahmad
• Omar Ahmed
• Sanaria Ahmed, M.A.
• Jung Young Ahn
• Laura J Ahn, O.D.

• General Practice Dentistry in Arcadia, CA
• Providers in Arcadia, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.