Provider Demographics
NPI:1891153342
Name:SIBONA, AGUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:
Last Name:SIBONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SUPERIOR AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3668
Mailing Address - Country:US
Mailing Address - Phone:949-764-8960
Mailing Address - Fax:949-764-8961
Practice Address - Street 1:520 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3637
Practice Address - Country:US
Practice Address - Phone:949-764-8960
Practice Address - Fax:949-764-8961
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA152943208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program