Provider Demographics
NPI:1033287883
Name:BAGALSO, CAROLINA DELA CRUZ (MA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:DELA CRUZ
Last Name:BAGALSO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:DELA CRUZ
Other - Last Name:BAGALSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:8775 AERO DR
Mailing Address - Street 2:SUITE 333
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1792
Mailing Address - Country:US
Mailing Address - Phone:858-836-1090
Mailing Address - Fax:858-836-1094
Practice Address - Street 1:8775 AERO DR
Practice Address - Street 2:SUITE 333
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1792
Practice Address - Country:US
Practice Address - Phone:858-836-1090
Practice Address - Fax:858-836-1094
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 50036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist