Basic Information
| Provider Information | |||||||||
| NPI: | 1023137403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGIU | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | LYN | ||||||||
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| Credential: | LM, RN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3521 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926598521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494362203 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1117 E DEVONSHIRE AVE | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925433083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516522811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 814348 | CA | N | Nursing Service Providers | Registered Nurse | 176B00000X | 208 | CA | N | Other Service Providers | Midwife | 363L00000X | 95011438 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.