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General NPI Number Information
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NPI Number | 1548558968
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Entity Type | Individual
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Provider Name | MARYLYN A. HAGERTY DNP FNP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 08/04/2018
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Provider Practice Location Address
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Address Line | 12900 PARK PLAZA DR STE 150
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City | CERRITOS
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State | CA
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Zip | 90703
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Country | US
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Telephone | 562-229-4831
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Fax | 949-305-8520
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Provider Business Mailing Address
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Address Line | 1808 CALLE MAYITA
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-2306
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Country | US
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Telephone | 949-933-2620
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Fax | 949-361-5092
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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 | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 21337
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 267941
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License Number State | CA
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