Provider Demographics
NPI:1295016368
Name:TAGAN, DOROTHY A (RN CPNP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:TAGAN
Suffix:
Gender:F
Credentials:RN CPNP
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Mailing Address - Street 1:30210 RANCHO VIEJO RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1574
Mailing Address - Country:US
Mailing Address - Phone:949-493-7337
Mailing Address - Fax:949-493-1418
Practice Address - Street 1:30210 RANCHO VIEJO RD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1574
Practice Address - Country:US
Practice Address - Phone:949-493-7337
Practice Address - Fax:949-493-1418
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA304991163W00000X
CA20274363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse