Provider Demographics
NPI:1073682225
Name:JOANNE G PAGAL DO INC.
Entity Type:Organization
Organization Name:JOANNE G PAGAL DO INC.
Other - Org Name:JOANNE G PAGAL DO DBA JOANNE G PAGAL DO INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-448-9728
Mailing Address - Street 1:25431 CABOT RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5518
Mailing Address - Country:US
Mailing Address - Phone:949-448-9728
Mailing Address - Fax:949-448-9732
Practice Address - Street 1:25431 CABOT RD
Practice Address - Street 2:SUITE 115
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5518
Practice Address - Country:US
Practice Address - Phone:949-448-9728
Practice Address - Fax:949-448-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H56964Medicare UPIN
CAW18335Medicare PIN