Healthcare Provider Details

I. General information

NPI: 1194037879
Provider Name (Legal Business Name): DAGHER MD MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 W BADILLO ST
COVINA CA
91723-1827
US

IV. Provider business mailing address

376 W BADILLO ST
COVINA CA
91723-1827
US

V. Phone/Fax

Practice location:
  • Phone: 626-332-1175
  • Fax: 626-966-8746
Mailing address:
  • Phone: 626-332-1175
  • Fax: 626-966-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA98565
License Number StateCA

VIII. Authorized Official

Name: NADIM DAGHER
Title or Position: OWNER
Credential: MD
Phone: 626-332-1175