Most Relevant Information
Provider Data
| NPI Number: | 1003465105 |
| Provider Name: | KENNETH PAOLO DAGDAG LISING MSN, APRN, FNP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 95012739 |
Most Important Dates
| Enumeration Date: | 09/11/2019 |
| Last Updated: | 11/11/2021 |
Provider Practice Location
2141 N HARBOR BLVD STE 25000
FULLERTON
CA
928353830
Practice Location Phone/Fax
| Phone: | 7146268650 |
| Fax: |
Provider Mailing Location
10283 JASMINE CT
STANTON
CA
906808505
Provider Mailing Phone/Fax
| Phone: | 7142621660 |
| Fax: |