Provider Demographics
NPI:1619528403
Name:PAINAGA, MARY DIVINE GRACE DINSAY (FNP)
Entity Type:Individual
Prefix:
First Name:MARY DIVINE GRACE
Middle Name:DINSAY
Last Name:PAINAGA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12415 RIVES AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3454
Mailing Address - Country:US
Mailing Address - Phone:626-586-5113
Mailing Address - Fax:
Practice Address - Street 1:12415 RIVES AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3454
Practice Address - Country:US
Practice Address - Phone:626-586-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily