Basic Information
| Provider Information | |||||||||
| NPI: | 1184914202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARZON LOPEZ | ||||||||
| FirstName: | AGUSTINA | ||||||||
| MiddleName: | CANDELARIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 N FINE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937271528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575650 | ||||||||
| FaxNumber: | 5594575695 | ||||||||
| Practice Location | |||||||||
| Address1: | 1945 N FINE AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594575650 | ||||||||
| FaxNumber: | 5594575695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2011 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 390200000X | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A132471 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.