Provider Demographics
NPI:1346049376
Name:BUAN-LAGAZO, NICO CACHO (RN, CNS)
Entity type:Individual
Prefix:
First Name:NICO
Middle Name:CACHO
Last Name:BUAN-LAGAZO
Suffix:
Gender:
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 BELLWETHER WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2706
Mailing Address - Country:US
Mailing Address - Phone:916-835-6393
Mailing Address - Fax:
Practice Address - Street 1:4131 BELLWETHER WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-2706
Practice Address - Country:US
Practice Address - Phone:916-835-6393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5067364SG0600X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health