Provider Demographics
NPI:1538410865
Name:AGOSTO, CLARIBEL (RPA-C)
Entity type:Individual
Prefix:MS
First Name:CLARIBEL
Middle Name:
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:CLARIBEL
Other - Middle Name:
Other - Last Name:CUEVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:20 YORK STREET, CB-329
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:203-384-4677
Mailing Address - Fax:203-384-3135
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-384-3882
Practice Address - Fax:203-384-3135
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016009363AM0700X
CT002976363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical