Healthcare Provider Details

I. General information

NPI: 1053130005
Provider Name (Legal Business Name): SALINA G DAGDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 05/13/2025
Certification Date: 10/07/2024
Deactivation Date: 12/18/2024
Reactivation Date: 05/13/2025

III. Provider practice location address

1627 WHITE BEAR AVE N
SAINT PAUL MN
55106-1609
US

IV. Provider business mailing address

1627 WHITE BEAR AVE N
SAINT PAUL MN
55106-1609
US

V. Phone/Fax

Practice location:
  • Phone: 651-278-7319
  • Fax:
Mailing address:
  • Phone: 651-278-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: