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MS. STEPHANIE AGONCILLO PA-C
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1427425172
Individual Registrant:MS. STEPHANIE AGONCILLO PA-C
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
2911 CHANTICLEER AVE SANTA CRUZ, CA 95065-1815 US
Tel: 831-477-2350 Fax: --
Tel: 831-477-2350 Fax: --
Contact information for business:
2911 CHANTICLEER AVE SANTA CRUZ, CA 95065-1815 US
Tel: 831-477-2350 Fax: --
Tel: 831-477-2350 Fax: --
Registration Information:
NPI: 1427425172
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | NC | |
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | CA | 53464 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
