Basic Information
| Provider Information | |||||||||
| NPI: | 1386617306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGUSTINES | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 CLEARWATER LARGO RD N | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337704131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275186444 | ||||||||
| FaxNumber: | 7275812678 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 CLEARWATER LARGO RD N | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337704131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275186444 | ||||||||
| FaxNumber: | 7275812678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 02/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME79384 | FL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | ME79384 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 268165000 | 05 | FL | MEDICAID |