Provider Demographics
NPI:1144621608
Name:BAGASAN, MARIA DE LEON
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LEON
Last Name:BAGASAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 DARTMOUTH ST
Mailing Address - Street 2:5R
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-575-8425
Mailing Address - Fax:
Practice Address - Street 1:6730 DARTMOUTH ST
Practice Address - Street 2:5R
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4057
Practice Address - Country:US
Practice Address - Phone:718-575-8425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist