Provider Demographics
NPI:1598395873
Name:LAGOS, MARISOL (PSS)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:LAGOS
Suffix:
Gender:F
Credentials:PSS
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:LAGOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8326 KELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4747 EARHART BLVD STE D
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-1747
Practice Address - Country:US
Practice Address - Phone:504-541-4031
Practice Address - Fax:985-781-4446
Is Sole Proprietor?:No
Enumeration Date:2020-01-25
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist