AUGUSTINE PROVENCIO

SANTA MONICA, CA
NPI1629810270
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy103TC2200X Psychologist, Clinical Child & Adolescent
Enumeration Date2024-06-12
Last Update Date2024-06-12
Business Address
AUGUSTINE PROVENCIO MS
1339 20TH ST
SANTA MONICA, CA 90404-2033
Phone number: 310-829-8708
Mailing Address
AUGUSTINE PROVENCIO MS
2779 GOLDENROD CT
MERCED, CA 95340-2772
Phone number: 209-756-2632
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