Provider Demographics
NPI:1639250319
Name:CABAGNOT, ADELITA TAJOLOSA (NP)
Entity Type:Individual
Prefix:
First Name:ADELITA
Middle Name:TAJOLOSA
Last Name:CABAGNOT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ADELITA
Other - Middle Name:FUENTES
Other - Last Name:TAJOLOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10945 LE CONTE AVE
Mailing Address - Street 2:STE 2339
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3000
Mailing Address - Country:US
Mailing Address - Phone:310-825-8253
Mailing Address - Fax:
Practice Address - Street 1:10945 LE CONTE AVE
Practice Address - Street 2:STE 2339
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3000
Practice Address - Country:US
Practice Address - Phone:310-825-8253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR230YMedicare PIN