Provider Demographics
NPI:1720732787
Name:DOJILLO, MARINA LAGASCA (NP)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:LAGASCA
Last Name:DOJILLO
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 1:2735 PETALUMA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1612
Mailing Address - Country:US
Mailing Address - Phone:562-668-8859
Mailing Address - Fax:
Practice Address - Street 1:2735 PETALUMA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1612
Practice Address - Country:US
Practice Address - Phone:562-668-8859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF01220035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily