Provider Demographics
NPI:1396472155
Name:PAGANO, OLIVIA (NP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:PAGANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 W COLORADO ST STE 205
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3640
Mailing Address - Country:US
Mailing Address - Phone:323-794-1403
Mailing Address - Fax:323-488-9782
Practice Address - Street 1:15211 VANOWEN ST STE 201
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3627
Practice Address - Country:US
Practice Address - Phone:818-574-3798
Practice Address - Fax:844-809-9305
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily