Healthcare Provider Details

I. General information

NPI: 1568385334
Provider Name (Legal Business Name): DANA ALYSSA LIWANAG AGUADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

1027 W ANGELENO AVE APT 111
BURBANK CA
91506-3419
US

V. Phone/Fax

Practice location:
  • Phone: 323-660-2450
  • Fax:
Mailing address:
  • Phone: 818-940-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95040567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: