Basic Information
| Provider Information | |||||||||
| NPI: | 1295016368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAGAN | ||||||||
| FirstName: | DOROTHY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | RN CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30210 RANCHO VIEJO RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SAN JUAN CAPISTRANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926751574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494937337 | ||||||||
| FaxNumber: | 9494931418 | ||||||||
| Practice Location | |||||||||
| Address1: | 30210 RANCHO VIEJO RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SAN JUAN CAPISTRANO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926751574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494937337 | ||||||||
| FaxNumber: | 9494931418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2011 | ||||||||
| LastUpdateDate: | 09/02/2011 | ||||||||
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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 | 304991 | CA | N | Nursing Service Providers | Registered Nurse | 363LP0200X | 20274 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.