Provider Demographics
NPI:1598189755
Name:DAGGI, THERESA (NP-C)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:DAGGI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18411 CLARK ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3506
Mailing Address - Country:US
Mailing Address - Phone:818-757-8839
Mailing Address - Fax:818-609-1036
Practice Address - Street 1:18411 CLARK ST
Practice Address - Street 2:SUITE 301
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3506
Practice Address - Country:US
Practice Address - Phone:818-757-8839
Practice Address - Fax:818-609-1036
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-08
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000331363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health