Healthcare Provider Details

I. General information

NPI: 1487811212
Provider Name (Legal Business Name): NIKHIL ARVIND DAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S FAIR OAKS AVE SUITE 215
PASADENA CA
91105-2613
US

IV. Provider business mailing address

3452 E FOOTHILL BLVD STE 130
PASADENA CA
91107-6006
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-4139
  • Fax: 626-304-8280
Mailing address:
  • Phone: 626-793-2885
  • Fax: 626-793-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA110624
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA110624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: