Healthcare Provider Details

I. General information

NPI: 1972440659
Provider Name (Legal Business Name): NANCY MAE D DADIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

6339 CAPETOWN ST
LAKEWOOD CA
90713-1703
US

V. Phone/Fax

Practice location:
  • Phone: 844-562-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number492704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: