Provider Demographics
NPI:1265671713
Name:LAGUNA, JOSE ROBERTO (LAC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ROBERTO
Last Name:LAGUNA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W ANDERSON LN
Mailing Address - Street 2:STE 512
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1159
Mailing Address - Country:US
Mailing Address - Phone:512-467-0370
Mailing Address - Fax:512-454-8846
Practice Address - Street 1:2700 W ANDERSON LN
Practice Address - Street 2:STE 512
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1159
Practice Address - Country:US
Practice Address - Phone:512-467-0370
Practice Address - Fax:512-454-8846
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00352171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist