Provider Demographics
NPI:1033861604
Name:SAPALO, DAHLIA OCTAVIANO (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DAHLIA
Middle Name:OCTAVIANO
Last Name:SAPALO
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 AGA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA RITA
Mailing Address - State:GU
Mailing Address - Zip Code:96915-1508
Mailing Address - Country:US
Mailing Address - Phone:671-489-1366
Mailing Address - Fax:
Practice Address - Street 1:151 AGA DR
Practice Address - Street 2:
Practice Address - City:SANTA RITA
Practice Address - State:GU
Practice Address - Zip Code:96915-1508
Practice Address - Country:US
Practice Address - Phone:671-489-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUNP0240363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology