Provider Demographics
NPI:1548014608
Name:PAGUIO, CARMELYN FATIMA MAGLALANG (RDHAP)
Entity type:Individual
Prefix:
First Name:CARMELYN FATIMA
Middle Name:MAGLALANG
Last Name:PAGUIO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ANGWIN PLZ UNIT 314
Mailing Address - Street 2:
Mailing Address - City:ANGWIN
Mailing Address - State:CA
Mailing Address - Zip Code:94508-1010
Mailing Address - Country:US
Mailing Address - Phone:707-339-8060
Mailing Address - Fax:
Practice Address - Street 1:2249 STAGECOACH CANYON RD
Practice Address - Street 2:
Practice Address - City:POPE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94567-9425
Practice Address - Country:US
Practice Address - Phone:707-339-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA926124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist