Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 208 | CA |
Y | 363L00000X | Nurse Practitioner | 95011438 | CA |
NPI | 1023137403 |
---|---|
Provider Name | Kristin Lyn Bagiu |
First Address | Newport Beach, CA 92659-8521 |
Second Address | Hemet, CA 92543-3083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 01/07/2019 |