Provider Demographics
NPI:1568129468
Name:HAGAN, NORA GUARINO
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:GUARINO
Last Name:HAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2746 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5250
Mailing Address - Country:US
Mailing Address - Phone:858-599-3664
Mailing Address - Fax:
Practice Address - Street 1:1120 PEPPER DR SPC 84
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-1323
Practice Address - Country:US
Practice Address - Phone:619-995-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4421813OtherDRIVER LICESNE