Healthcare Provider Details

I. General information

NPI: 1598189755
Provider Name (Legal Business Name): THERESA DAGGI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2014
Last Update Date: 02/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18411 CLARK ST SUITE 301
TARZANA CA
91356-3506
US

IV. Provider business mailing address

18411 CLARK ST SUITE 301
TARZANA CA
91356-3506
US

V. Phone/Fax

Practice location:
  • Phone: 818-757-8839
  • Fax: 818-609-1036
Mailing address:
  • Phone: 818-757-8839
  • Fax: 818-609-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95000331
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: