AUGUSTINE PROVENCIO

LOS ANGELES, CA
NPI1629810270
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy103T00000X Psychologist
Additional Taxonomies103TC2200X Psychologist, Clinical Child & Adolescent
Enumeration Date2024-06-12
Last Update Date2025-08-27
Business Address
AUGUSTINE PROVENCIO MS
4650 W SUNSET BLVD # 53
LOS ANGELES, CA 90027-6062
Phone number: 323-361-3849
Mailing Address
AUGUSTINE PROVENCIO MS
2779 GOLDENROD CT
MERCED, CA 95340-2772
Phone number: 209-756-2632
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