Provider Demographics
NPI:1104493485
Name:NEGRETE, MIGUEL (RPSGT)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:NEGRETE
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10351 CAMINITO SURABAYA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1634
Mailing Address - Country:US
Mailing Address - Phone:855-597-1196
Mailing Address - Fax:
Practice Address - Street 1:10351 CAMINITO SURABAYA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1634
Practice Address - Country:US
Practice Address - Phone:855-597-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTGL296156F00000X
251E00000X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No251E00000XAgenciesHome Health