Provider Demographics
NPI:1134834302
Name:LAGUN, VENICIA
Entity type:Individual
Prefix:
First Name:VENICIA
Middle Name:
Last Name:LAGUN
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 1:3894 CRENSHAW BLVD # 56165
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-6049
Mailing Address - Country:US
Mailing Address - Phone:844-524-6463
Mailing Address - Fax:
Practice Address - Street 1:4206 7TH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-4729
Practice Address - Country:US
Practice Address - Phone:310-903-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA194700876376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker