Provider Demographics
NPI:1992921142
Name:AGUSTINO, ELVIRA DUNCIL (RN MSN)
Entity type:Individual
Prefix:MRS
First Name:ELVIRA
Middle Name:DUNCIL
Last Name:AGUSTINO
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 ZURICH DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2954
Mailing Address - Country:US
Mailing Address - Phone:619-424-7329
Mailing Address - Fax:
Practice Address - Street 1:690 OXFORD ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7111
Practice Address - Country:US
Practice Address - Phone:619-409-3134
Practice Address - Fax:619-409-3388
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN453866171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator