Provider Demographics
NPI:1275044703
Name:DAGALA, GEENA (NP)
Entity Type:Individual
Prefix:
First Name:GEENA
Middle Name:
Last Name:DAGALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SNOOKY
Other - Middle Name:GENALIN
Other - Last Name:DAGALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7659 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CLINIC OF MANUEL F MENDOZA, MD
Practice Address - Street 2:11735 FIRESTONE BLVD
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:562-925-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007818363LP2300X, 363LF0000X
CA749726163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily