Healthcare Provider Details

I. General information

NPI: 1023137403
Provider Name (Legal Business Name): KRISTIN LYN BAGIU LM, RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SOUTH ST
LAKEWOOD CA
90712-1498
US

IV. Provider business mailing address

PO BOX 3521
NEWPORT BEACH CA
92659-8521
US

V. Phone/Fax

Practice location:
  • Phone: 562-531-2550
  • Fax:
Mailing address:
  • Phone: 949-436-2203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number290673
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95011438
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number814348
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: