Provider Demographics
NPI:1255447496
Name:NAGEL, IRENE KAJIYA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:KAJIYA
Last Name:NAGEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:AIKO
Other - Last Name:KAJIYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:18035 BROOKHURST ST., SUITE 1300
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:657-241-9440
Mailing Address - Fax:714-665-4601
Practice Address - Street 1:18035 BROOKHURST ST., SUITE 1300
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:657-241-9440
Practice Address - Fax:714-665-4601
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15487363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP17919Medicare UPIN