Healthcare Provider Details

I. General information

NPI: 1396472155
Provider Name (Legal Business Name): OLIVIA PAGANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15211 VANOWEN ST STE 201
VAN NUYS CA
91405-3627
US

IV. Provider business mailing address

541 W COLORADO ST STE 205
GLENDALE CA
91204-3640
US

V. Phone/Fax

Practice location:
  • Phone: 818-574-3798
  • Fax: 844-809-9305
Mailing address:
  • Phone: 323-794-1403
  • Fax: 323-488-9782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: