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MS. STEPHANIE AGONCILLO PA-C

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1427425172

Individual Registrant:
MS. STEPHANIE  AGONCILLO PA-C
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: --

Contact information for business:
2911 CHANTICLEER AVE  SANTA CRUZ, CA 95065-1815 US
Tel: 831-477-2350  Fax: --

Registration Information:
NPI: 1427425172
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
NC
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
CA53464

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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