Healthcare Provider Details

I. General information

NPI: 1982970794
Provider Name (Legal Business Name): GENEROSA DAGOHOY DINGAL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E SAMPLE RD STE 3-4
POMPANO BEACH FL
33064-5138
US

IV. Provider business mailing address

750 E SAMPLE RD STE 3-4
POMPANO BEACH FL
33064-5138
US

V. Phone/Fax

Practice location:
  • Phone: 561-674-5215
  • Fax:
Mailing address:
  • Phone: 561-674-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA51966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: