Provider Demographics
NPI:1609166099
Name:LAGUNA FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:LAGUNA FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILORIA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:949-499-2265
Mailing Address - Street 1:32392 COAST HWY
Mailing Address - Street 2:STE. 250
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6776
Mailing Address - Country:US
Mailing Address - Phone:949-499-2265
Mailing Address - Fax:949-499-2276
Practice Address - Street 1:32392 COAST HWY
Practice Address - Street 2:STE. 250
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6776
Practice Address - Country:US
Practice Address - Phone:949-499-2265
Practice Address - Fax:949-499-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LCS274261041C0700X
LCS271771041C0700X
CAMFT40203106H00000X
CAA819162084P0804X
CANP14715363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty