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General NPI Number Information
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NPI Number | 1003465105
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Entity Type | Individual
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Provider Name | KENNETH PAOLO DAGDAG LISING MSN, APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 11/11/2021
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Provider Practice Location Address
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Address Line | 2141 N HARBOR BLVD STE 25000
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City | FULLERTON
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State | CA
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Zip | 92835-3830
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Country | US
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Telephone | 714-626-8650
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Fax |
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Provider Business Mailing Address
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Address Line | 10283 JASMINE CT
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City | STANTON
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State | CA
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Zip | 90680-8505
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Country | US
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Telephone | 714-262-1660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95012739
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License Number State | CA
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