Healthcare Provider Details

I. General information

NPI: 1639863103
Provider Name (Legal Business Name): DALAL AAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 03/22/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5468 EL CAJON BLVD
EL CAJON CA
92115
US

IV. Provider business mailing address

5468 EL CAJON BLVD
EL CAJON CA
92115
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2400
  • Fax: 602-429-8595
Mailing address:
  • Phone: 619-515-2400
  • Fax: 602-429-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR79961
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: