Provider Demographics
NPI:1710764709
Name:DAGATAN, ISAIAH
Entity Type:Individual
Prefix:
First Name:ISAIAH
Middle Name:
Last Name:DAGATAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 N MARKS AVE APT 127
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-1640
Mailing Address - Country:US
Mailing Address - Phone:559-253-3211
Mailing Address - Fax:
Practice Address - Street 1:6050 N MARKS AVE APT 127
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-1640
Practice Address - Country:US
Practice Address - Phone:559-253-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No183700000XPharmacy Service ProvidersPharmacy Technician