Provider Demographics
NPI:1326502147
Name:LAGUNA HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:LAGUNA HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARNICKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-552-5664
Mailing Address - Street 1:PO BOX 1407
Mailing Address - Street 2:
Mailing Address - City:LAGUNA
Mailing Address - State:NM
Mailing Address - Zip Code:87026-1407
Mailing Address - Country:US
Mailing Address - Phone:505-552-5664
Mailing Address - Fax:
Practice Address - Street 1:282 CASA BLANCA RD
Practice Address - Street 2:
Practice Address - City:CASA BLANCA
Practice Address - State:NM
Practice Address - Zip Code:87007
Practice Address - Country:US
Practice Address - Phone:505-552-0163
Practice Address - Fax:505-552-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty