Provider Demographics
NPI:1518144310
Name:LAGUNA HONDA HOSPITAL
Entity Type:Organization
Organization Name:LAGUNA HONDA HOSPITAL
Other - Org Name:LAGUNA HONDA HOSPITAL - ENTERAL FEEDING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSP ASSOC ADMIN, PATIENT FIN SERV
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-206-3286
Mailing Address - Street 1:1001 POTRERO AVE BLDG 10
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8338
Mailing Address - Fax:415-206-3837
Practice Address - Street 1:375 LAGUNA HONDA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1411
Practice Address - Country:US
Practice Address - Phone:415-759-3348
Practice Address - Fax:415-759-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0575430001Medicare NSC