Provider Demographics
NPI:1538465265
Name:MATHIS, DAGMAR J
Entity Type:Individual
Prefix:
First Name:DAGMAR
Middle Name:J
Last Name:MATHIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DAGMAR
Other - Middle Name:J
Other - Last Name:MATHIS-PASCUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2008 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2722
Mailing Address - Country:US
Mailing Address - Phone:909-623-6131
Mailing Address - Fax:
Practice Address - Street 1:2008 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2722
Practice Address - Country:US
Practice Address - Phone:909-623-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner