Provider Demographics
NPI:1437979697
Name:FUNG-BAGAMASBAD, CATHERINE (FNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:FUNG-BAGAMASBAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3992 S SOMERSTON WAY
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-3825
Mailing Address - Country:US
Mailing Address - Phone:510-504-0952
Mailing Address - Fax:
Practice Address - Street 1:2195 CLUB CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4162
Practice Address - Country:US
Practice Address - Phone:909-654-2199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily