Provider Demographics
NPI:1619452869
Name:DONGALLO, KRISTEL PADUA (NP)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:PADUA
Last Name:DONGALLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CESAR CHAVEZ AVE
Mailing Address - Street 2:SUITE 536
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033
Mailing Address - Country:US
Mailing Address - Phone:323-264-4300
Mailing Address - Fax:
Practice Address - Street 1:1701 CESAR CHAVEZ AVE.,
Practice Address - Street 2:SUITE 536
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:818-324-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1346348638207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology