Provider Demographics
NPI:1679896674
Name:NEAGOS, NEGOITA (MPA-C)
Entity Type:Individual
Prefix:
First Name:NEGOITA
Middle Name:
Last Name:NEAGOS
Suffix:
Gender:M
Credentials:MPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15211 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3606
Mailing Address - Country:US
Mailing Address - Phone:818-782-3255
Mailing Address - Fax:818-782-7026
Practice Address - Street 1:15211 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3606
Practice Address - Country:US
Practice Address - Phone:818-782-3255
Practice Address - Fax:818-782-7026
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant