Healthcare Provider Details

I. General information

NPI: 1386742542
Provider Name (Legal Business Name): HAI DAGOBERG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD RM 1225
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

6962 DERBY CIR
HUNTINGTON BEACH CA
92648-1563
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-3070
Mailing address:
  • Phone: 323-684-9798
  • Fax: 310-268-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH 38397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: