Healthcare Provider Details

I. General information

NPI: 1770991119
Provider Name (Legal Business Name): JOSHUA DAGCUTA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 SULLIVAN AVE SUITE 330
DALY CITY CA
94015-2221
US

IV. Provider business mailing address

279 BAY RIDGE DR
DALY CITY CA
94014-1570
US

V. Phone/Fax

Practice location:
  • Phone: 650-756-5630
  • Fax: 650-756-0136
Mailing address:
  • Phone: 415-205-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95000899
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: