Healthcare Provider Details

I. General information

NPI: 1154397107
Provider Name (Legal Business Name): JAMES JOSEPH DAGOSTINO DPT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 PLAZA DR STE 112
OCEANSIDE CA
92056-4625
US

IV. Provider business mailing address

3809 PLAZA DR STE 112
OCEANSIDE CA
92056-4625
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-2630
  • Fax: 760-941-4617
Mailing address:
  • Phone: 760-941-2630
  • Fax: 760-941-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: