Provider Demographics
NPI:1811717234
Name:BAGANG, ABIGAILE SALVADOR (RN)
Entity type:Individual
Prefix:
First Name:ABIGAILE
Middle Name:SALVADOR
Last Name:BAGANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9416 BROXTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5095
Mailing Address - Country:US
Mailing Address - Phone:757-533-2979
Mailing Address - Fax:
Practice Address - Street 1:9416 BROXTON AVE
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5095
Practice Address - Country:US
Practice Address - Phone:757-533-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95335048163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse