Healthcare Provider Details

I. General information

NPI: 1275044703
Provider Name (Legal Business Name): GEENA DAGALA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SNOOKY GENALIN DAGALA NP

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 07/09/2022
Certification Date: 07/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLINIC OF MANUEL F MENDOZA, MD 11735 FIRESTONE BLVD
NORWALK CA
90650
US

IV. Provider business mailing address

7659 GRANADA DR
BUENA PARK CA
90621-1212
US

V. Phone/Fax

Practice location:
  • Phone: 562-925-7716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95007818
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number749726
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: