Provider Demographics
NPI:1285058727
Name:PISIGAN, DOMINIC LEGASPI (NP-C)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:LEGASPI
Last Name:PISIGAN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:MR
Other - First Name:DOMINIC
Other - Middle Name:
Other - Last Name:LEGASPI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:565 CHARMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2131
Mailing Address - Country:US
Mailing Address - Phone:626-277-1434
Mailing Address - Fax:
Practice Address - Street 1:565 CHARMINGDALE RD
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2131
Practice Address - Country:US
Practice Address - Phone:626-277-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 23825364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health