Provider Demographics
NPI:1376661322
Name:LIWAG, REMEDIOS BANGALAN (RN,PHN)
Entity Type:Individual
Prefix:
First Name:REMEDIOS
Middle Name:BANGALAN
Last Name:LIWAG
Suffix:
Gender:F
Credentials:RN,PHN
Other - Prefix:
Other - First Name:REMEDIOS
Other - Middle Name:LADDARAN
Other - Last Name:BANGALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1056 FUCHSIA LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:690 OXFORD ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7111
Practice Address - Country:US
Practice Address - Phone:619-409-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN499593163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health