Provider Demographics
NPI:1962717306
Name:MAGLASANG, DOMINIKA (CPNP)
Entity type:Individual
Prefix:
First Name:DOMINIKA
Middle Name:
Last Name:MAGLASANG
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 WELCH RD FL 1
Mailing Address - Street 2:SURGICAL SPECIALTIES CLINIC
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1503
Mailing Address - Country:US
Mailing Address - Phone:650-497-8263
Mailing Address - Fax:650-497-8891
Practice Address - Street 1:730 WELCH RD FL 1
Practice Address - Street 2:SURGICAL SPECIALTIES CLINIC
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1503
Practice Address - Country:US
Practice Address - Phone:650-497-8263
Practice Address - Fax:650-497-8891
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18320363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics