Elaine Grace Agustin, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP 13423 Issued in CA

Practice address

401 E Highland Ave
Suite 551
San Bernardino, CA 92404-3803

Phone

(909) 882-9150

Fax

(909) 883-8972

NPI assigned

Mar 9, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1992837843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4485 CLEVELAND AVE",
            "address_2": "APT 5",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921163985",
            "telephone_number": "626-484-7719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E HIGHLAND AVE",
            "address_2": "SUITE 551",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924043803",
            "telephone_number": "909-882-9150",
            "fax_number": "909-883-8972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGUSTIN",
        "first_name": "ELAINE",
        "middle_name": "GRACE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-09",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP 13423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED NURSE",
            "identifier": "RN 549365",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER",
            "identifier": "NP 13423",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy Aguirre, PHARMD
• Angelica Aguirre
• Marissa Aguirre
• Matthew Vince Aguirre, PMHNP
• Stephanie Aguirre
• Aura Lee Ah Kiong
• David Ahamba, M.D.
• Ahcs San Bernardino, LLC
• Ahcs San Bernardino, LLC
• William B. Ahnn, M.D.

• Nurse Practitioner in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.