Provider Demographics
NPI:1891525218
Name:PINTO GONZALEZ, AGUSTINA
Entity type:Individual
Prefix:
First Name:AGUSTINA
Middle Name:
Last Name:PINTO GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 CANFIELD RD APT 10
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-2948
Mailing Address - Country:US
Mailing Address - Phone:571-337-8879
Mailing Address - Fax:
Practice Address - Street 1:4135 BOARDMAN CANFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9803
Practice Address - Country:US
Practice Address - Phone:571-337-8879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001274933163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse