Provider Demographics
NPI:1841694270
Name:JANET AGU
Entity type:Organization
Organization Name:JANET AGU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:AGU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:562-565-0699
Mailing Address - Street 1:4000 LONG BEACH BLVD
Mailing Address - Street 2:228
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2617
Mailing Address - Country:US
Mailing Address - Phone:562-637-3143
Mailing Address - Fax:562-637-3143
Practice Address - Street 1:4000 LONG BEACH BLVD
Practice Address - Street 2:228
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2617
Practice Address - Country:US
Practice Address - Phone:562-637-3143
Practice Address - Fax:562-637-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP23549363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty