Provencio, Augustine

Provencio, Augustine is an sole proprietor health care provider with primary practice located at 1339 20Th St , Santa Monica CA 90404-2033. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as his primary health care specialty. Provencio, Augustine can be contacted via phone (310) 829-8708.

Contact Information

Primary practice address
1339 20Th St Santa Monica CA 90404-2033
Phone: (310) 829-8708
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X

Profile Details

NPI number 1629810270
LBN Legal business name Provencio, Augustine
Credentials MS
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 12th, 2024
Last updated Jun 12th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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